PD solutions play an increasingly important role in current peritoneal dialysis research and development. In the 1920s, Ganter used a physiological saline solution, to which glucose was added later. In 1938, Jonathan Rhoads began adding lactate to the solution to correct metabolic acidosis, which can develop if the kidneys are unable to eliminate acidic metabolic products. More than 60 years later, lactate remains the most commonly used buffer in PD solution. However, today there are also solutions containing pure bicarbonate or a mixture of the two substances, bicarbonate and lactate, to balance the acid-base status. As a substitute for glucose, dialysis solutions can also contain amino acids or glucose polymers.


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New biocompatible peritoneal dialysis solution in a double bag


In the early 1980s, a widely recognized article by Axel Duwe was published, discussing the effects of individual components of PD solution on peritoneal efficiency on bacterial killing for the first time. A few years later the term “bio(in)compatibility” appeared to indicate the body’s (in)tolerance of dialysis solutions. At the time, studies showed that conventional PD solutions could inhibit the activities of key cells in the peritoneum and cause long-term damage to the membrane. These complications lad to a gradual weakening of the peritoneal membrane and make it unsuitable for further use as a dialyzer. Conventional dialysis solutions have a non-physiological pH below that of the peritoneum and a high concentration of glucose degradation products. Both contribute significantly to the bioincompatibility of solutions. Now, PD solutions are offered in multi-chamber bags that have a neutral to physiological pH and a significantly lower amount of glucose degradation products.

The introduction of this new generation of PD solutions is a promising start for the development of better, more biocompatible solutions. The results of recent studies inspire confidence that new PD solutions can extend the dialyzer function of the peritoneum. Actually, a clinical study showed that a new, more biocompatible PD solution can extend a patient’s survival.

This brief look at the history of peritoneal dialysis illustrates the fascinating interaction between the ideas, resourcefulness and determination of many pioneers and dedicated scientists. The success of their efforts is reflected in modern peritoneal dialysis which has attained a solid position in today’s kidney replacement therapy.