The peritoneum in perspective: extracellular vesicles and the future of peritoneal dialysis

Peritoneal dialysis (PD) transforms the peritoneum into a dynamic therapeutic interface, with each exchange offering direct access to molecular and cellular signals from the peritoneal cavity. Among these, extracellular vesicles (EVs) have emerged as stable, information-rich messengers reflecting peritoneal health, inflammation, and fibrosis. The review explores the peritoneum as a living therapeutic interface, summarizing current evidence on EV biology, their molecular cargo, and potential roles in monitoring inflammation, fibrosis, and membrane function. It also discusses existing knowledge gaps, technological advances, and opportunities for translating EV research into clinical practice.