Conventional versus biocompatible peritoneal dialysis fluids: more questions than answers?

Abstract

The most important challenge in peritoneal dialysis (PD) is long-term preservation of peritoneal membrane structure and function. Introduction of dialysis fluids into the peritoneal cavity induces changes. These changes are related to duration of dialysis, occurrence of peritonitis and components of the dialysis solution. Bioincompatibility is considered to be the major cause of the development of morphological changes of the peritoneal membrane. pH neutral PD fluids that are low in glucose degradation products (GDP) seem to better preserve the peritoneal membrane and have less systemic effects than the conventional ones. However, the long-term effects are not clear. An overview of the effects of conventional PD fluids and glucose-based PD fluids with neutral pH in ex vivo and in vivo animal and clinical studies is presented.

Bidirectional Relationship Between Reduced Blood pH and Acute Pancreatitis: A Translational Study of Their Noxious Combination

“…By supplementing the oral treatment with i.p. acidification, our model also accounted for such conditions, when primarily the pH of the peritoneal fluid is reduced such as bacterial peritonitis (Glinska-Suchocka et al, 2016 ), carbon dioxide insufflation during laparoscopy (Duerr et al, 2008 ), or peritoneal dialysis (Farhat et al, 2008 ). Notably, in our model, MA developed gradually and persisted for several days in the mice which is very similar to the development of MA in human patients.…”

Influence of peritoneal dialysis solution biocompatibility on long-term survival of patients on continuous ambulatory peritoneal dialysis and the technique itself

“…Long-term technique survival on CAPD by bioincompatible PD solutions was addressed by many authors, but there were no studies to confirm the effects of new biocompatible PD solutions on the technique and patients survival after a follow-up period of more than two years 22 . Thus, 1-, 2-, and 3-year technique survival rates were 86.0%, 73.6% and 60.5%, respectively, for Korean, and 89.%, 65.9% and 51.9%, respectively, for Swedish patients 2 .…”

“…Most of recent studies had a short follow-up (of only 6-12 months) for the confirmation of the effects of new biocompatible PD solutions on peritoneal transport, technique and patients survival 22 . The long-term effects of pH neutral PD solutions that are low in glucose degradation products (GDP) are not clear.…”