Innovations in peritoneal dialysis

Peritoneal dialysis used to be a common treatment for acute kidney failure that required dialysis. In favor of continuous, extracorporeal renal replacement procedures, it disappeared from the scene in the western world, whereas it continues to be used in structurally poor countries due to its simplicity and low resource intensity. Recently, the shortages in medical care in the context of the coronavirus disease 2019 (COVID-19) pandemic led to renewed worldwide interest in peritoneal dialysis as a safe option in acute kidney failure requiring dialysis. The introduction of biocompatible solutions 20 years ago was expected to reduce mortality or technical failure. Unfortunately, so far this could only be implied but not confirmed in studies. Immunomodulatory adjuvants are an innovative option which have the potential to improve the local immunocompetence and prevent the loss of peritoneal function. Currently, the vision of a wearable artificial kidney is getting closer. Intensification of dialysis dose also appears achievable with minimal dialysate volumes. In times of global warming, the regeneration of dialysates could not only save relevant amounts of water but also have a favorable impact on the CO2 balance. In summary, peritoneal dialysis is currently enjoying a comeback. This article describes the current and future developments of this procedure.