Peritoneal dialysis solutions for the 21st century

Existing peritoneal dialysis (PD) solutions were formulated for the maintenance of fluid and electrolyte balance, correction of metabolic acidosis, and the removal of metabolic waste products. Solutions currently in development are designed to improve biocompatibility by neutralizing pH and reducing glucose degradation products. PD solutions developed for the 21st century will address major clinical needs related to the maintenance of adequate nutrition, improvement of cardiovascular comorbidity, preservation of peritoneal membrane function, and adequacy of dialysis. Nutrineal is the first example of a PD solution to address such a clinical need. Another example is a low sodium solution to improve sodium balance thereby reducing the incidence of hypertension and the need for antihypertensive medication. New solutions under investigation will employ additives to protect the peritoneal membrane during peritonitis and chronic PD and to optimize PD therapy via improvements in ultrafiltration and solute clearances. Examples include the use of antioxidants to reduce oxidative damage during peritonitis and the use of glycosaminoglycans or other additives to enhance ultrafiltration. Future concepts include remodeling of the peritoneum, for example, the use of mesothelial gene therapy to introduce metabolic and anabolic machinery to remove or perpetually recycle metabolic wastes. The 21st century promises to be an exciting and fruitful time for the investigation and development of new products for the improvement of PD therapy.