Peritoneal dialysis solutions

Abstract

Peritoneal dialysis (PD) solutions contribute to homeostasis in patients with end stage renal disease (ESRD) by removing accumulated electrolytes and toxins, maintaining acid-base balance, and removing excess fluid through ultrafiltration. To achieve these functions, current PD solutions are an electrolyte solution of sodium, calcium and magnesium to which an osmotic agent and a buffer are added. Glucose remains the most used osmolyte, although icodextrin and amino acid solutions are also available. Icodextrin is a glucose polymer that confers the advantage of sustained ultrafiltration and minimal metabolite absorption. Amino acid solutions are used in patients as a form of nutritional supplementation. Older PD solutions used lactate as the buffer, but lactate/bicarbonate and bicarbonate only buffered solutions are more physiological and increasingly used. Accumulated evidence of local and systemic effects of PD fluids due to low pH and glucose degradation products (GDPs) has led to a drive towards more biocompatible solutions. Thus, the wide variety of PD solutions can be tailored for a patient specific management approach. © 2013 Springer-Verlag Berlin Heidelberg.