Table 1.

Table comparing the main characteristics of traditional versus biocompatible PD with emphasis on in vitro/in vivo mechanisms of toxicity.

PD solution	Traditional PD fluids	Biocompatible PD fluids
PD solution type	Traditional PD solutions	Neutral pH, Low GDPs	Icodextrin based	Amino acid based
Osmotic agent	Glucose	Glucose	Icodextrin	Amino acids
pH	5.5	6.8-7.3	5.5	~6.7
Toxic Agents	GDPs, AGEs, ROS, acidic pH, lactate buffer	Significant reduction of toxic agents (GDPs, AGEs, ROS)	Acid pH, lactate buffer, ROS	High concentration of amino acids
Mechanisms of cytotoxicity	TGFβ and VEGF, acceleration of TIMP release, inflammatory cytokines (IL-6, IL-1β) production	↓ osmolality	Iron accumulation, ↑ maltose and maltotriose serum level	Protein accumulation
in vitro effects	MMT induction, ECM deposition, increased stiffness, fibrosis, MC apoptosis	Improvement in cellular functions	pH-dependent apoptosis	Increase in nitrogenous waste metabolism
in vivo effects	Peritonitis, vasculopathy, disruption of renal functions, anuria, infusion pain, diabetic glomerulosclerosis	Probable reduction in ultrafiltration; ↑ urine volume	Hypoglycemia, skin rush	Acidosis, uremia
Benefits	Ultrafiltration efficiency, Lower costs	Preservation of residual renal functions, reduction of peritonitis risk	Increased daily ultrafiltration, reduced glucose adsorption, increased glycemic control of diabetic PD patients, improvement of cardiac parameters	Improved surrogate markers of nutritional status of malnourished PD patients
References	45, 46, 48, 53, 54, 59	3, 55–58	3, 55, 56, 58, 60, 61	3, 55, 56, 58, 62–65