Conventional peritoneal dialysis (PD) solutions are characterized by several undesirable characteristics, including acidic pH (5.2–5.5), high glucose concentrations (13.6–42.5 g/L), hyperosmolarity (360–511 mOsm/kg) and relatively high concentrations of glucose degradation products (GDPs). These characteristics have been shown to result in adverse clinical outcomes, including acute peritoneal membrane toxicity (manifested as inflow pain), chronic peritoneal toxicity (including membrane failure, ultrafiltration failure, peritonitis and encapsulating peritoneal sclerosis) and adverse systemic sequelae (including hyperglycaemia, dyslipidaemia, metabolic syndrome, cardiovascular disease and residual renal function decline). Consequently, there has been a great interest in manufacturing newer solutions with more ‘biocompatible’ features to mitigate these adverse effects. This has led to the development of neutral‐pH, low or ultralow GDP solutions, glucose‐sparing PD solutions (icodextrin and amino acid solutions), solutions using alternative osmotic agents (such as hyperbranched polyglycerol) and low‐sodium PD solutions. The aim of this chapter is to provide an up‐to‐date comprehensive review of all types of PD solutions that are currently available, including their impact on patient‐level outcomes.
Part of the book: Some Special Problems in Peritoneal Dialysis
Indoxyl sulphate (IS) and p-cresyl sulphate (PCS) are products of proteolytic bacterial fermentation by gut microbiota. They accumulate in the sera of patients with chronic kidney disease (CKD) and have been associated with CKD progression and cardiovascular and all-cause mortality. Therapeutic strategies for lowering IS and PCS include increased clearance (enhanced dialysis), gastrointestinal sequestration (oral adsorbents), reduced synthesis (dietary protein restriction, dietary fibre augmentation and pre-, pro- or synbiotics), antioxidants and organic anion transporter modulators. This review will discuss the roles of IS and PCS as therapeutic targets and examine the clinical evidence for different treatment options and their effects on CKD and cardiovascular disease risk. We will include our group’s research with pre-, pro- and synbiotic interventions to mitigate serum uraemic toxin accumulation and modify cardiovascular and renal risk.
Part of the book: Chronic Kidney Disease