Increasing the use of biocompatible, glucose-free peritoneal dialysis solutions

Core Tip

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.