Peritoneal dialysis allows solute and water transport. Adequate PD depends on a good function of the peritoneal membrane. The quality of the peritoneal membrane may be reduced at the start of PD in some patients, but in most peritoneal morphological and functional alterations develop with time on PD. Glucose based dialysis solutions, inflammation and infections are conceivable enemies for peritoneal integrity. Sadie van Esch describes the effects of potential enemies on the peritoneal membrane.