Is the peritoneal dialysis biocompatibility hypothesis dead?

The peritoneal dialysis (PD) biocompatibility hypothesis is that conventional PD solutions with high levels of glucose degradation products (GDPs), glucose and lactate, and low pH cause morphological and functional damage to the peritoneal membrane and that this damage may be attenuated by biocompatible solutions. Functional findings from randomized trials have not supported this hypothesis, and now new data from a large European pediatric peritoneal biopsy study provide a morphologic correlate for this. The implications are discussed.