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  • Review Article
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An update on peritoneal dialysis solutions

Nature Reviews Nephrology volume 8, pages 224–233 (2012)Cite this article

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Abstract

Peritoneal dialysis (PD) has achieved its current position as the most commonly used home-based dialysis therapy—and with patient survival equal to that seen with hemodialysis—despite the use of glucose-based dialysis solutions with high concentrations of glucose, glucose degradation products and lactate, high osmolality, and low pH, features that are harmful both for the peritoneum and the patient. Newer PD solutions with alternative buffers, a higher pH and fewer glucose degradation products, or ones that contain icodextrin or amino acids as osmotic agents, have been introduced in many countries and have been shown to improve peritoneal membrane health and viability. Icodextrin solution enhances fluid and sodium removal, and the once-daily use of icodextrin and/or amino acid solutions can lessen the harmful effects caused by the exposure of the peritoneal membrane to glucose. However, whether the newer PD solutions improve patient survival over the older solutions is not clear. Use of PD therapy, with or without the newer PD solutions, is associated with an improvement in patient survival that is equivalent to that obtained with hemodialysis. Therefore, the conventional glucose-based solutions—despite their known negative features—continue to have a well-established role in PD therapy, particularly in the many countries where the newer PD solutions are not easily available.

Key Points

  • Newer peritoneal dialysis (PD) solutions are less harmful for the peritoneal membrane than are conventional glucose-based solutions

  • Non-glucose-based PD solutions offer some protection against the metabolic effects of peritoneal glucose exposure

  • Icodextrin-based solutions improve fluid and sodium removal during the long (8–12 h) dialysis exchange, particularly in patients with an increased peritoneal solute transport rate

  • No firm evidence is available to support improved patient survival with the newer PD solutions

  • Patient survival on PD, both with conventional and with newer PD solutions, is comparable to survival on hemodialysis

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Figure 1: A schematic presentation of the potential beneficial effects of newer peritoneal dialysis solutions.

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Authors and Affiliations

  1. Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K56 Karolinska University Hospital Huddinge, Stockholm, S-141 86, Sweden

    Elvia García-López & Bengt Lindholm

  2. Department of Nephrology, Keele University, University Hospital of North Staffordshire, Royal Infirmary, Princess Road, Stoke-on-Trent, ST4 7LN, Staffordshire, UK

    Simon Davies

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  1. Elvia García-López
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The authors contributed equally to all aspects of this article.

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Correspondence to Bengt Lindholm.

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Competing interests

Bengt Lindholm is employed by Baxter Healthcare Corporation, owns stock options from Baxter Healthcare Corporation and receives research funding from Baxter Healthcare Corporation. Simon Davies declares an association with Baxter Healthcare Corporation (consultant, speaker's bureau, grant/research support) and is a consultant and has received honoraria for speaking from Gambro and Fresenius Medical Care. Elvia García-López declares no competing interests.

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García-López, E., Lindholm, B. & Davies, S. An update on peritoneal dialysis solutions. Nat Rev Nephrol 8, 224–233 (2012). https://doi.org/10.1038/nrneph.2012.13

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