What's new in peritoneal dialysis: biocompatibility and continuous flow peritoneal dialysis.

Purpose Of Review: This review examines recent developments in the understanding of the effect of conventional, bioincompatible peritoneal dialysis fluids on structural and functional changes in the peritoneal membrane. Emphasis is placed on the clinically relevant outcome of failure of long-term peritoneal dialysis. Therapeutic strategies to prevent technique failure, including the use of new peritoneal dialysis fluids and continuous flow peritoneal dialysis, are explored.

Recent Findings: Long-term (greater than 6 months) exposure to new peritoneal dialysis fluids with physiologic pH, lower lactate concentrations, or lower concentrations of glucose degradation products results in improved leukocyte cytokine release, ultrafiltration, and mesothelial cell mass, respectively. Continuous flow peritoneal dialysis allows efficient small molecule removal using dialysate with lower glucose concentration and possibly less glucose degradation products. Recent technical advances include creation of a double-lumen peritoneal dialysis catheter, and methods of monitoring intra-abdominal pressure and ultrafiltration.

Summary: Though initial reports with biocompatible peritoneal dialysis fluids are promising, the efficacy of these new solutions in preventing long-term peritoneal dialysis failure is unproven. Conditions in which new peritoneal dialysis fluids may be beneficial are suggested. Continuous flow peritoneal dialysis requires substantial technical improvements before this technique can be widely accepted.