Peritoneal dialysis (PD) is the method of renal replacement therapy used by close to 200,000
end stage renal disease patients worldwide to help replace the functions that are no longer
performed by their kidneys. An important advantage of PD is it offers an alternative to
hemodialysis that can be safely performed by patients in their own homes. In PD, the
peritoneal membrane that lines the abdomen acts as a dialyzer that allows the transfer of
solutes and water between the membrane capillaries and a dialysis solution that is infused
into the peritoneal cavity. PD dialysis solutions typically require high concentrations of
glucose to adequately perform these functions. Over time the continued exposure of the
peritoneal membrane to high concentrations of glucose can permanently damage the membrane.
Icodextrin is a polyglucose molecule that has been developed for use in PD solutions that
does not harm the peritoneal membrane. However, its use can lead to inadequate fluid removal.
Recent research has focused on finding a PD solution, or combination of solutions, that will
maximize the removal of toxic substances and metabolites while maintaining regulation of
fluid and electrolyte balance in the body. A bimodal solution that combines glucose and
icodextrin has been shown in observational studies to be effective and safe. The
investigators propose a randomized, controlled, blinded study that will determine the
effectiveness and safety of this bimodal fluid in a Canadian PD population. The investigators
hypothesize that the use of the bimodal solution during the long (day) dwell will lead to an
improvement in 24 hour ultrafiltration efficiency as compared to usual care using icodextrin
for the long dwell.