New developments in peritoneal dialysis solutions

Existing peritoneal dialysis (PD) solutions were formulated mainly for the maintenance of fluid and electrolyte balance, correction of metabolic acidosis, and the removal of metabolic waste products. New solutions in development, and recently approved in some countries, are designed to improve ultrafiltration during long dwells (polyglucose or icodextrin solutions), to treat malnutrition (amino-acids solutions), and to improve peritoneal biocompatibility (bicarbonate-buffered solutions). Other new solutions under investigation are designed to address unmet clinical needs, including cardiovascular disease and sodium balance, through the use of a low-sodium PD solution; long-term peritoneal viability, through improvements in sterilization processes and the use of nonglucose osmotic agents; and PD adequacy, through the use of solution additives (such as glycosaminoglycans) and tailored PD prescriptions using APD. Future concepts for PD include remodeling of the peritoneum, perhaps using mesothelial gene therapy to introduce metabolic and anabolic machinery to remove or perpetually recycle metabolic wastes.