New solutions for peritoneal dialysis in adult and pediatric patients

Abstract

Glucose is almost universally used as an osmotic agent in peritoneal dialysis (PD) solutions. The major advantages of glucose are that it produces high ultrafiltration rates at relatively low mass concentrations; it is readily metabolized; it is safe; and it has beneficial nutritional value, especially for patients with poor calorie intake. Glucose-containing solutions are also relatively inexpensive and easy to manufacture. The major drawbacks of glucose as an osmotic agent include inadequate ultrafiltration during long-dwell exchanges, particularly in patients with high peritoneal permeability; worsening of metabolic abnormalities owing to the peritoneal glucose load; and potential local adverse effects in the peritoneum owing to the bioincompatible aspects of standard lactate-buffered PD solutions. Because of the drawbacks, which are indeed applicable in adult patients as well as in pediatric patients, there has been continued research and development of new PD solutions. Efforts have been focused mainly on three areas. The first area is the replacement of glucose with equally small molecular weight substances, such as amino acids, to alter the metabolic profile. The second area is the replacement of glucose with large molecular weight substances such as glucose polymers to enhance ultrafiltration while minimizing absorption of the osmotic agent, thereby reducing metabolic side effects. The final area is providing PD solutions that contain bicarbonate as a buffer and that are thus pH-neutral, with improved biocompatibility profiles. This paper will focus on clinical experience with these three new commercially available solutions.