Long-term peritoneal dialysis is associated with alterations in peritoneal function, like the development of high small solute transfer rates and impaired ultrafiltration. Also, morphologic changes can develop, the most prominent being loss of mesothelium, vasculopathy, and interstitial fibrosis. Current research suggests peritoneal inflammation as the driving force for these alterations. In this review, the available evidence for inflammation is examined and a new hypothesis is put forward consisting of high glucose-induced pseudohypoxia. Hypoxia of cells is characterized by a high (oxidized-reduced nicotinamide dinucleotide ratio) NADH-NAD⁺ ratio in their cytosol. Pseudohypoxia is similar but occurs when excessive amounts of glucose are metabolized, as is the case for peritoneal interstitial cells in peritoneal dialysis. The glucose-induced high NADH-NAD⁺ ratio upregulates the hypoxia-inducible factor-1 gene, which stimulates not only the glucose transporter-1 gene but also many profibrotic genes like TGFβ, vascular endothelial growth factor, plasminogen activator inhibitor-1, and connective tissue growth factor, all known to be involved in the development of peritoneal fibrosis. This review discusses the causes and consequences of pseudohypoxia in peritoneal dialysis and the available options for treatment and prevention. Reducing peritoneal exposure to the excessively high dialysate glucose load is the cornerstone to avoid the pseudohypoxia-induced alterations. This can partly be done by the use of icodextrin or by combinations of low molecular mass osmotic agents, all in a low dose. The addition of alanyl-glutamine to the dialysis solution needs further clinical investigation.

长期腹膜透析与腹膜功能的改变有关，例如小溶质转移率高和超滤受损。此外，还会发生形态学变化，最突出的是间皮缺失、血管病变和间质纤维化。目前的研究表明腹膜炎症是这些改变的驱动力。在这篇综述中，检查了炎症的现有证据，并提出了一个新的假设，即高葡萄糖诱导的假性缺氧。细胞缺氧的特点是细胞质中NADH-NAD ⁺比率较高（氧化还原烟酰胺二核苷酸比率） 。假性缺氧与之类似，但当代谢过量的葡萄糖时就会发生假性缺氧，就像腹膜透析中腹膜间质细胞的情况一样。葡萄糖诱导的高 NADH-NAD ⁺比例上调缺氧诱导因子-1 基因，不仅刺激葡萄糖转运蛋白-1 基因，还刺激许多促纤维化基因，如 TGF β、血管内皮生长因子、纤溶酶原激活剂抑制剂-1、和结缔组织生长因子，已知它们都与腹膜纤维化的发展有关。本综述讨论了腹膜透析中假性缺氧的原因和后果以及可用的治疗和预防方案。减少腹膜暴露于过高的透析液葡萄糖负荷是避免假性缺氧引起的改变的基石。这可以部分地通过使用艾考糊精或低分子质量渗透剂的组合来实现，所有这些都以低剂量进行。在透析溶液中添加丙氨酰谷氨酰胺需要进一步的临床研究。