title: Studying the effects of new peritoneal dialysis solutions on the peritoneum.
abstract: BACKGROUND
  Compelling data underscore the bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and their detrimental effects on peritoneal physiology and morphology. New PD solutions have been formulated to tackle common clinical problems such as inadequate ultrafiltration or malnutrition, and to improve biocompatibility-the latter aimed at preserving the structural and functional integrity of the peritoneum and reducing adverse systemic effects on the patient.
  
  
  METHODS
  This article reviews the factors in PD fluids that alter normal peritoneal anatomy and physiology, and the data that illustrate approaches to investigating the local and systemic biocompatibility of new PD solutions.
  
  
  RESULTS
  Chronic exposure of the peritoneal membrane to glucose-based PD solutions results in denudation of the mesothelium, thickened submesothelium, and hyalinization of the vasculature, often resulting in reduced or lost solute and water clearance. Data from in vitro or animal experiments and clinical studies have shown improved biocompatibility profiles with new PD solutions that are glucose-free (that is, dialysates with amino acids or icodextrin), bicarbonate-buffered, or compartmentalized during heat sterilization to reduce levels of glucose degradation products. Improved biocompatibility is denoted by reduced induction of proinflammatory, profibrotic, or angiogenic growth factors in mesothelial cells and macrophages, or by less perturbation of leukocyte phagocytic function.
  
  
  CONCLUSIONS
  Data from in vitro and animal experiments show more favorable biocompatibility profiles with new PD fluids than with glucose-based dialysates. Clinical studies are ongoing to assess the impact of the new PD fluids on peritoneal function, morbidity, and mortality.
authors.affiliation: Department of Medicine, University of Hong Kong, Hong Kong SAR, PR China. dtmchan@hkucc.hku.hk
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Susan
authors.initials: S
authors.lastname: Yung
mesh_terms: D000596:Amino Acids; D000818:Animals; D001639:Bicarbonates; D001672:Biocompatible Materials; D002021:Buffers; D015314:Dialysis Solutions / Q000737:chemistry* / Q000494:pharmacology; D005936:Glucans; D005947:Glucose; D006801:Humans; D000077607:Icodextrin; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects*
chemical_list: D000596:Amino Acids; D001639:Bicarbonates; D001672:Biocompatible Materials; D002021:Buffers; D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose