New peritoneal dialysis fluids: practical use for children

In recent years several new peritoneal dialysis solutions have come onto the market. These solutions differ from the conventional ones with respect to osmotic agent, buffer, and/or calcium concentration. Icodextrin-containing solutions are characterized by slow, but sustained ultrafiltration. Experience in both adults and children has been favorable for the long dwell period, giving rise to both increased ultrafiltration and clearances. The use of icodextrin during the daytime seems ideal in patients on nightly intermittent peritoneal dialysis with a low peritoneal ultrafiltration rate. However, long-term experience still has to be obtained, particularly in children. The application of pH-neutral solutions, containing bicarbonate, lactate, or a bicarbonate/lactate mixture as a buffer, has shown better preservation of peritoneal cells and better tolerance. The standard calcium concentration of 1.75 mmol/l of the dialysis solution is too high in many situations. Individual strategies for an adequate calcium balance are required depending on age, clinical situation, and oral intake of calcium and vitamin D metabolites.