New Peritoneal Dialysis Solutions and Solutions on the Horizon

The following will be discussed in this chapter: (1) effects of alterations in electrolytes, (2) amino acids, (3) icodextrin, (4) neutral pH, low/ultralow glucose degradation product “biocompatible” PD solutions, and (5) bicarbonate- and/or lactate-buffered solutions. Both high and low dialysate magnesium concentrations can have unwanted side effects, but a concentration of 0.5 mmol/L will probably be adequate for most patients. A calcium concentration of 1.25 mmol/L has less side effects than 1.75 mmol/L, but close monitoring of the development of hyperthyroidism is required. Low dialysate sodium concentrations enhance sodium removal from the body and lowers blood pressure, but such solutions are not commercially available. Nutritional effects of a 1.1% amino acid-based solution are limited, but one exchange per day can be used to reduce peritoneal glucose exposure. Icodextrin 7.5% for the long exchange provides sustained ultrafiltration and provides more ultrafiltration than 3.86%/4.25% glucose dialysate. However, its use is limited to one daily exchange to prevent excessive maltose accumulation. Combinations with low molecular osmotic agents are interesting, but not commercially available. Biocompatible dialysis solutions are characterized by a neutral pH and reduced concentrations of glucose degradation products, such as aldehydes and dicarbonyl compounds. Their use is associated with better preservation of residual renal function and less inflow pain. Their use leads to better peritoneal histology and possibly to better preservation of peritoneal transport function. It is unclear if the composition of the buffer is important.