New Fluids for Peritoneal Dialysis : why do we need them and what is it about?

Peritoneal dialysis (PD) fluids generate concentration and osmotic gradients across the peritoneal membrane to remove uremic toxins and to achieve ultrafiltration. The use of current-era dialysis fluids also drives peritoneal and systemic pro-inflammatory, pro-fibrotic and pro-angiogenic processes that could be linked to patient outcomes. As the most frequent causes of PD technique failure are mortality, infections, insufficient solute clearance and ultrafiltration failure, it is important to reflect on the effects and modifiable power of the PD fluids’ compositions. This paper discusses the peritoneal and systemic effects of glucose-based PD fluids and the evidence on the use of icodextrin and amino-acid based alternatives. Recent innovations in PD fluids try to overcome the peritoneal and systemic toxicities of current formulations by using an alternative osmotic agent and/or by counteracting the metabolic effects of the carbohydrate load by the PD fluid.