Future technologies and techniques in peritoneal dialysis-opportunities and challenges ahead

In the last 5 years, we have started to witness the emergence of new technologies and techniques that offer the potential for improved patient outcomes but which often still lack clinical demonstration and/or confirmation in well-designed, multicentre studies. These include biocompatible solutions, glucose sparing regimens, low-sodium solutions, bimodal solution formulations and continuous flow peritoneal dialysis (CFPD). This review discusses the potential benefits ascribable to each of these technologies and an analysis of the challenges that have to be surmounted before anyone of these candidate technologies can be declared as established. The demonstration of either hard clinical endpoints or validated surrogate endpoints is very feasible in terms of sample size requirements for some outcome measures, such as preservation of RRF, but will be much more challenging for other endpoints such as preservation of UF capacity.