This review outlines the problems involved in assessing the biocompatibility of PD fluids. It has summarized the data available from conventional in vitro studies and highlights many of the inadequacies of this approach. In viva data are lacking both on host defense and on the clinical effect of changing conven tional PD fluids for a more “ideal” formulation. The best parameters for assessing biocompatibility need to be defined. Alternative formulation of fluids must be aimed towards (1) a system that interferes minimally with host defense, and (2) a system that maintains the integrity of the peritoneal membrane for ultrafiltration and clearance.
Cell culture studies should be designed to model the in viva situation. Ex viva studies (cells exposed within the peritoneal cavity) should be used to support in viva findings. Finally, in vitra results must be related to clinical significance, and changes in fluid composition should be followed by improvements in clinical outcome.
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