CD Laboratory for Peritoneal Regulation of the Immune-Metabolic Ecosystem in Peritoneal Dialysis

The primary function of the kidneys is to filter the blood and excrete waste products and toxins through the urine. In the case of kidney failure, these substances remain in the body and must be artificially removed by dialysis. Peritoneal dialysis (PD) uses the peritoneum, the membrane surrounding the abdominal organs, as a natural filtration barrier. A special dialysis fluid is infused into the abdominal cavity via a catheter. After several hours, the dialysate, now enriched with metabolic waste products, toxins, salts, and excess water, is drained. Ideally, dialysis serves as a bridge to kidney transplantation.

However, the treatment of chronic kidney failure by dialysis is often complicated by comorbidities. Overall, this results in an approximately 40-fold higher mortality rate compared to healthy individuals. A major contributing factor is chronic inflammation, which is associated with increased susceptibility to infections and a higher risk of cardiovascular disease. Both kidney failure itself and dialysis-specific side effects are currently considered potential drivers of these inflammatory processes.

The glucose-containing dialysis solutions used in PD contribute to the development of so-called metabolic inflammation (metaflammation). This form of chronic, metabolism-associated inflammation plays a role in the pathogenesis of various metabolic diseases, such as diabetes mellitus, and has been intensively studied in those contexts. In PD, however, this area remains insufficiently investigated, and significant research gaps persist.

In the CD Laboratory PRIME-PD, the underlying mechanisms of these complications are systematically studied to establish a comprehensive scientific basis for novel therapeutic approaches. A particular focus is placed on the liver as a potentially key and therapeutically modifiable driver of harmful metaflammation. The underlying disease mechanisms and their modifiability are investigated in experimental models of PD.

Importantly, the abdominal cavity itself does not merely undergo passive damage and fibrosis as a result of chronic PD treatment. Recent findings suggest that it also functions as an active immunological organ. Signals originating from the peritoneal cavity may trigger or amplify metaflammation.

The CD Laboratory employs innovative and promising high-resolution methods to visualize proteins and gene products directly within tissue. This enables key disease processes to be identified and analyzed in a targeted manner, forming the basis for the development of innovative therapeutic strategies. The improved understanding of metaflammation will also support the development of novel dialysis solutions that promote immunologically beneficial metabolic processes.

In addition, the laboratory addresses important emerging research questions for which only limited data are currently available. These include the role of circadian rhythms in PD, long-term inflammatory memory following PD, and sex-specific differences in disease progression and therapeutic response.

In summary, this CD Laboratory investigates entirely new and highly relevant disease mechanisms and their therapeutic modifiability through targeted interventions. The findings are expected to provide decisive impulses for innovation, ultimately leading to longer and improved survival of patients with kidney disease undergoing PD. Moreover, the insights gained extend beyond PD, deepening the understanding of metaflammation-driven diseases and opening new therapeutic avenues.