Continuous flow peritoneal dialysis: Solution formulation and biocompatibility

When peritoneal dialysis was introduced several years ago an important alte rnative dialysis therapy to hemodialysis was made available for the treatme nt of end-stage chronic disease. However, a continuous search for new devel opments and technologies is necessary to find the optimal peritoneal dialys is fluid (PDF) to preserve peritoneal membrane function as long as possible . Conventional PDFs are known to compromise the functional integrity of the peritoneal membrane as a consequence of their acidic pH in combination wit h their high lactate content, as well as the high concentrations of glucose and glucose degradation products (GDPs) present in currently used conventi onal solutions. Novel solutions such as bicarbonate-buffiered PDF (at neutr al pH) display improved in vitro biocompatibility as compared to convention al, acidic lactate-buffered PDF. Since these novel solutions are manufactur ed in dual-chambered bags they also contain fewer GDPs, thus further reduci ng their potential toxicity and protein glycation. Clinically the novel sol utions reduce inflow pain and improve peritoneal membrane transport charact eristics, ultrafiltration capacity, and effluent markers of peritoneal memb rane integrity. The concept of continuous flow peritoneal dialysis (CFPD) i s another approach to optimize PDF. The technique of CFPD not only enables the individualization of acid-base correction by variable concentrations of HCO3- but may also help to restore peritoneal cell functions by neutral pH , reduced glucose load, diminished GDP content, and reduced advanced glycat ion end product (AGE) formation, thereby potentially contributing to the im proved preservation of peritoneal membrane function.