Breaking barriers in peritoneal fibrosis: extracellular vesicles as promising diagnostic and therapeutic strategy

BACKGROUND: Peritoneal dialysis is an essential therapy for end-stage kidney disease, but its long-term efficacy is severely limited by peritoneal fibrosis. Driven by mesothelial-mesenchymal transition, inflammation and angiogenesis, this pathological process leads to treatment failure and increased mortality. The urgent need for effective therapies has shifted research focus to extracellular vesicles-phospholipid bilayer nanovesicles that shuttle bioactive cargoes to modulate pathogenic pathways, positioning them as key mediators in peritoneal fibrosis. DISCUSSION: biodynamics and unconfirmed long-term safety in clinical translation. CONCLUSION: Extracellular vesicles hold great potential as novel non-invasive biomarkers and targeted therapeutic agents for peritoneal fibrosis. This review outlines a developmental roadmap for extracellular vesicles-based strategies by combining mechanistic findings with translational challenges. Addressing these critical gaps will be pivotal to unlocking the clinical value of extracellular vesicles, preserving peritoneal membrane function and improving long-term outcomes for relevant patients.