[Which is the best peritoneal dialysis solution?]

Peritoneal dialysate is formulated to achieve some therapeutic goals including removal of excess fluid, normalization of serum electrolytes, correction of the acid-base balance. An osmotic agent is necessary to induce an ultrafiltration. Glucose is almost universally used achieving a good ultrafiltration rate, with many advantages and some disadvantages. Alternative osmotic agents have been sought; most of them were other sugars: the longest experience was with the glycerol; but some experience was gained with xylitol and maltose. Other components such as amino acids and glucose polymers were suggested with some experience. The major electrolytes are included in the dialysate at levels calculated to achieve normalization of serum levels: sodium level in the dialysate is between 132 and 136 mmol/l, potassium level between 0 and 2 mmol/l calcium level between 1.6 and 2 mmol/l and magnesium level between 0 and 0.5 mmol/l. To control metabolic acidosis it is necessary to use a buffered dialysate: lactate should be used and acetate abandoned. Recently a new bicarbonate solution was proposed. Water quality has to be compared to intravenous fluids. Aluminum level must be very low (less than 0.30 mumol/l) and other trace elements at the lowest value.