Peritoneal Dialysis International | 2021
Non-polyvinyl chloride peritoneal dialysis sets: A double-edged sword?
Abstract
In this issue of Peritoneal Dialysis International, a multicentre randomized controlled trial from Malaysia found locally made peritoneal dialysis (PD) sets containing polyvinyl chloride (PVC) had similar peritonitis rates, Kt/V, and creatinine clearance to overseas-made sets that were non-PVC. Many meta-insights are worth making in the wake of this large and well-performed trial. Before doing so, it is worth repeating the context and rationale for the trial. In 2017, Fresenius Medical Care (Asia Pacific) opened a PD manufacturing plant in Malaysia to provide products for the region. In the process, they changed the specifications of the locally available transfer sets in Malaysia to include (1) minor differences in the dimensions of tubing without substantial modification of flow path design and (2) a change from non-PVC to PVC tubing. Both the old and new PD fluid containers were non-PVC, twocompartment in design, and the dialysis fluids bicarbonatebased. In response, the Ministry of Health in Malaysia sponsored a trial comparing the old and new sets to ensure non-inferiority of clinical effectiveness. The rationale for the trial included concerns around the impact of PVC on the clinical effectiveness of PD, and the possibility of manufacturing defects arising from differences in quality control between the new local plant and the previous one in Europe. What is the concern regarding the use of PVC? As background, PVC is a polymer of vinyl chloride, derived from mineral oil, natural gas, and salt (universal recycling