22 - Peritoneal Dialysis Solutions

Abstract

Peritoneal dialysis (PD) is a form of home-based kidney replacement therapy (KRT) used to treat patients suffering from kidney failure. Understanding the principles behind PD solution compositions and their mechanisms of action is central to ensuring safe and effective prescribing of PD to optimize patient outcomes. Conventional PD solutions, despite their widespread use, have undesirable properties that result in mesothelial cell death, peritoneal injury, and nephrotoxicity. Therefore, the use of glucose-sparing strategies (such as substituting icodextrin and/or amino acid for glucose) and biocompatible solutions (neutral pH, low glucose degradation product [GDP]) is recommended to mitigate the peritoneal and systemic complications of conventional PD solutions. Icodextrin has been shown to be effective in augmenting ultrafiltration, reducing fluid overload, and possibly improving glycemic control in patients with diabetes. Amino acid solutions have not been shown to be effective as a nutritional intervention and cannot be routinely recommended for this purpose or as a glucose-sparing strategy presently. Neutral-pH, low-GDP solutions lead to preservation of residual kidney function, but their long-term effects on patient-important outcomes remain uncertain. As a result, there are several ongoing experimental works to try to improve the currently available PD solutions. Glycerol, l-carnitine, and hyperbranched polyglycerol have been studied with the hope of developing a novel and more biocompatible PD solution. This chapter aims to review PD solutions and the evidence underpinning their use.