Current Progress in Peritoneal Dialysis: A Narrative Review of Progress in Peritoneal Dialysis Fluid

Peritoneal dialysis (PD) is a renal replacement therapy that removes solutes, electrolytes, and water via the infusion of dialysis fluid into the peritoneal cavity. However, the non-physiological composition of conventional PD fluids can cause peritoneal injury, leading to complications such as peritoneal fibrosis and encapsulating peritoneal sclerosis. This review highlights recent advancements in PD fluid formulations aimed at improving biocompatibility and reducing peritoneal damage. While glucose-based solutions remain the standard because of their affordability, their glucose degradation products (GDPs) and advanced glycation end-products significantly contribute to peritoneal fibrosis. Innovations, such as neutral pH and low-GDP solutions, have been developed to counter these effects, enhancing peritoneal integrity and preserving residual renal function. Alternative osmotic agents, such as icodextrin, offer superior ultrafiltration. Advancements in buffer formulations, including bicarbonate-based and bicarbonate/lactate combinations, have further enhanced the biocompatibility of PD fluids. Despite these progressions, challenges persist. Therefore, future research should prioritize patient-specific PD solutions to optimize long-term outcomes and minimize adverse effects.