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A Journal on Nephrology and Urology

Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536

Frequency: Bi-Monthly

ISSN 0393-2249

Online ISSN 1827-1758


Minerva Urologica e Nefrologica 2006 June;58(2):145-60


Peritoneal dialysis solutions - At a crossroad

Diaz-Buxo J. A. 1, Gotloib L. 2,3

1 Fresenius Medical Care North America Home Therapies Development Lexington, MA, USA
2 Department of Nephrology and Hypertension Ha’Emek Medical Center Afula, Israel
3 Research Center for Experimental Nephrology Ha’Emek Medical Center, Afula, Israel

After many decades of evolution and with many choices available for the formulation of peritoneal dialysis fluids (PDF), we find ourselves at a crossroads. A review of related developments, laboratory trials and clinical evaluations is offered to stimulate future research in this area. The information presented here raises more questions than it provides answers, but opens the door to innumerable possibilities for improvement. The search for a biocompatible osmotic agent designed to replace those currently used has been frustrating and is far from being considered a success. Research on cytokines and other mediators of inflammation produced a huge amount of interesting scientific knowledge that may help our understanding. However, it is unlikely that it will identify a specifically targeted anticytokine, or combination of them, designed to neutralize and/or reverse inflammatory changes resulting from the use of poorly biocompatible PDF. The development of low glucose degradation product (GDP) solutions by means of multi-chambered bags appear to be a step in the right direction and perhaps is the most significant improvement in this field in many decades. GDPs are important, but not the only offenders or the exclusive source of oxidative stress. Thus, the addition of antioxidants to PDF formulations, in our opinion, deserves further consideration. Additionally, repopulation of the mesothelial monolayer by means of periodic autotransplantation of mesothelial cells may well become a useful tool to prevent and/or correct membrane failure. We are fortunate to have choices at this crossroad, which we must evaluate rigorously.

language: English


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