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Article Commentary: Biocompatibility and Peritoneal Transport

147 The rationale for the development of the so-called biocompatible dialysis solution is the observation that severe peritoneal abnormalities may develop in longterm peritoneal dialysis (PD) patients. Exposure to conventional dialysis solutions is likely to be one of the pathogenetic factors. Ultrafiltration failure is the most common clinical manifestation of a damaged peritoneal membrane. All biocompatible solutions have reduced concentrations of glucose degradation products (GDPs) and, in some, the lactate buffer is partially or totally replaced by bicarbonate. Long-term exposure to some of these biocompatible solutions in rats has shown an attenuation of fibrosis and neoangiogenesis compared with conventional fluids (1–3). A patient was recently described who was treated for 4 years with low-GDP neutral-pH solutions and did not develop any morphological or functional peritoneal abnormality (4). A number of controlled observational follow-up studies on biocompatible dialysis fluids with various designs and solutions have been published (5–12). With the exception of the study by Rippe et al. (7), duration of treatment ranged from 2 months to 1 year. Three studies were done in incident patients (10–12), the others were in prevalent patients or a mixture of both (5–9). A somewhat better ultrafiltration was reported in only one study (6). None of the others found differences in the timecourse of solute or water transport between the biocompatible and the conventional solutions during a standardized 4-hour dialysis exchange. This is not unexpected because the peritoneal abnormalities seen in long-term patients take some years to develop. Acute exposure to a dialysis solution in rats causes transient increases in peritoneal arteriolar blood flow and leads to capillary recruitment, which may result in a larger effective peritoneal surface area during the initial phase of an exchange (13). The effects were espeBIOCOMPATIBILITY AND PERITONEAL TRANSPORT