Questions About PD
We thank you for your question. Much of the clearance in PD is through diffusion (uremic solutes and potassium moving from a higher level of concentration in the peritoneal capillary blood into the PD fluid in the abdomen). Using a hypertonic 4.25% dextrose PD solution will give you slightly more clearance than using either a 1.5% or 2.5% dextrose PD solution, since there will be additional clearance of solutes with the increased amount of ultrafiltration from the 4.25% (this increased clearance is through convective transport).
However, today, regular use of 4.25% dextrose PD solutions is not at all recommended for patients for either fluid volume management or improved clearance/adequacy for the following reasons: may adversely affect peritoneal membrane function; will cause increased glucose absorption leading to worsening control of blood sugars, if diabetic; and will promote obesity.
Reference: Daugirdas, J.T., Blake, P.G. and Todd. S. (2015). Handbook of Dialysis, 5th edition. Philadelphia: Wolters Klewer.