1. In peritoneal dialysis the removal of excess body water (ultrafiltration) is traditionally achieved by means of dialysis solution made hypertonic to plasma by the addition of an osmotic agent. In vitro, the osmotic flow may be directed against the osmolality gradient by using a hypo-osmolar solution, but this phenomenon has not previously been applied to clinical peritoneal dialysis.

2. The ultrafiltration performances of hypo-osmolar dialysis solutions containing a high-molecular-weight glucose polymer (weight average molecular weight 22 000), isolated by fractionation of hydrolysed corn starch, were compared with those of hypertonic glucose solutions over a 12 h exchange in 11 patients well established on continuous ambulatory peritoneal dialysis.

3. Five per cent (272 +1.1 mosmol/kg) and 7.5% (277 + 2.0 mosmol/kg) glucose polymer solutions produced net ultrafiltration of 243 +53 and 526 +59 ml that were significantly greater than the ultrafiltration of −48 +96 and 223 +84 ml associated with 1.36% (339 +1.9 mosmol/kg) and 2.27% (393 +3.2 mosmol/kg) glucose solutions, respectively. The net ultrafiltration with 10% glucose polymer (284 +2.0 mosmol/kg) and 3.86% glucose (482 + 1.6 mosmol/kg) solutions were similar (699 +48 versus 708 +82 ml).

4. The transperitoneal absorption of glucose polymer was substantially lower than that of glucose solutions as was the potential calorie load per millilitre of ultrafiltrate.

5. The addition of 0.35% glucose (molecular weight 180) to 7.5% glucose polymer solution raised the dialysate osmolality to an iso-osmolar level (299 +0.8 mosmol/kg) and produced ultrafiltration which was 29% greater than with 7.5% glucose polymer solution alone.

6. The demonstration of ultrafiltration with hypo-osmolar dialysate represents an important advance towards the formulation of a physiological iso-osmolar dialysis solution, which may have long-term benefits over the conventional hypertonic solutions. The iso-osmolar combination of ‘colloid’ and ‘crystalloid’ osmotic agents looks promising with a potential for a wide range of ultrafiltration capabilities as well as metabolic correction.

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