Peer-review started: June 15, 2014
First decision: September 28, 2014
Revised: October 7, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 6, 2015
Processing time: 238 Days and 5.3 Hours
A major concern inhibiting some clinicians from embracing peritoneal dialysis (PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis, encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, “biocompatible” and glucose-sparing PD regimens have been developed to minimize damage to the peritoneal membrane. Can the use of these more expensive solutions be justified on current evidence? In this review of the literature, we explore how we may individualize the prescription of biocompatible PD fluid.
Core tip: There is increasing evidence of benefit for using biocompatible and non-glucose based peritoneal dialysis (PD) fluids. However, cost remains an impediment and perhaps there are selected groups of patients where the cost can be justified. We suggest that biocompatible solutions should be considered for patients with residual renal function and/or expected to remain on PD for a long period. They are particularly helpful for patients with drain-in pains. The targeting of diabetic patients for non-glucose solutions is intriguing given the recent IMPENDIA/EDEN study although vigilance is required to minimize unaware hypoglycemia. It remains to be seen if PD nephrologists are willing to take the same leap of faith that our hemodialysis (HD) colleagues took when they moved from Acetate-based HD solutions to Bicarbonate dialysate. It is possible that economies of scale will reduce the cost of the biocompatible solutions if we use them more frequently.