Original Article Use of locally prepared peritoneal dialysis (PD) fluid for acute PD in children and infants in Africa Mignon I McCulloch 1 , Peter Nourse 1 and Andrew C Argent 2 Abstract Background: In less well-resourced countries, the high cost of commercially available peritoneal dialysis (PD) fluid limits its use. The major concerns regarding bedside-prepared PD fluid is peritonitis as well as electrolyte disorders. The aim of this study was to review our experience with the use of PD fluids prepared at the bedside using the intravenous infusion solution Balsol (Fresenius Kabi). Methods: This was a retrospective review of all patients who received PD for acute kidney injury (AKI) using a bedside- prepared PD solution adapted from the intravenous solution Balsol in our intensive care unit. Results: In total, 49 cases of acute PD were performed. Of the 49 children, 21 (43%) were male. The ages of the patients ranged from newborn to 10.2 years (median 0.33 years). The weight of children ranged from 1.3 kg to 50 kg (median 4.1 kg). The type of PD catheters used: Cook catheters, 41 patients; Kimal peel-away, 10 patients; and surgical inserted Tenckhoff type of catheter, 2 patients. The duration of PD was 1–17 days (median 3 days) Complications included peritonitis in 2 of 49 patients and blocked catheter in 6 of 49 patients. There were no electrolyte disturbances as a result of the PD. Overall survival was 43% of patients. Conclusions: Locally prepared PD solutions at the bedside adapted from intravenous solutions can be used safely and effectively. This has important relevance for centres in less well-resourced countries, where commercially produced PD fluid is not available for the management of AKI. Keywords Balsol, bedside-prepared PD fluid, bicarbonate-based fluid, intravenous solutions Introduction When dialysis is provided for children with acute kidney injury (AKI), mortality is significantly improved, as reviewed recently for AKI in sub-Saharan Africa. 1 Perito- neal dialysis (PD) is ideal for the treatment of paediatric AKI in low-income countries 2,3 but is usually performed with commercially manufactured PD fluid and surgically inserted PD catheters. The Saving Young Lives Programme has promoted the use of PD in AKI in low- and middle- income countries, but some centres have struggled with sustainability because of the high cost of commercially prepared PD fluid. 4,5 The role of locally prepared dialysis fluids using commercially available intravenous fluids is very relevant in these settings. Although recipes are avail- able in the International Society for Peritoneal Dialysis (ISPD) guidelines 6 for the adaption of intravenous fluids to make PD solutions, very little is published in the modern era regarding the use of these types of fluids for dialysis. Because of the bedside addition of glucose and extra manipulation of the bags, physicians are generally reticent to prepare these fluids because of the possible increased risk of infection. In a recent retrospective study in 68 chil- dren and adults from Cameroon, bedside-prepared solu- tions adapted from intravenous solutions were shown to be as effective as commercially made solutions in terms of patient survival and peritonitis rate. 7 Although Flynn 1 Division of Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa 2 Division of Paediatric Critical Care, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa Corresponding author: Peter Nourse, Division of Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, Cape Town 7700, South Africa. Email: peter.nourse@uct.ac.za Peritoneal Dialysis International 1–5 ª The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0896860820920132 journals.sagepub.com/home/ptd