connection and fluid exchange systems (standard, twin-bag and y-set; the latter two involving two bags and only one connection to the catheter, the y-set uses a single y-shaped connection between the bags involving emptying, flushing out then filling the peritoneum through the same connection) the twin-bag and y-set systems were found superior to conventional systems at preventing peritonitis. The fluid used for dialysis uses glucose as a primary osmotic agent, but this may lead to peritonitis, the decline of kidney and peritoneal membrane function and other negative health outcomes. The acidity, high concentration and presence of lactate and products of the degradation of glucose in the solution (particularly the latter) may contribute to these health issues. Solutions that are neutral, use bicarbonate instead of lactate and have few glucose degradation products may offer more health benefits though this has not yet been studied. Volume Shifts The volume of dialysate removed as well as patient's weight are monitored. If more than 500ml of fluid are retained or a liter of fluid is lost across three consecutive treatments, the patient's physician is generally notified . Excessive loss of fluid can result in hypovolemic shock or hypotension while excessive fluid retention can result in hypertension and edema. Also monitored is the color of the fluid removed: normally it is pink-tinged for the initial four cycles and clear or pale yellow afterward. The presence of pink or bloody effluent suggests bleeding inside the abdomen while feces indicates a perforated bowel and cloudy fluid suggests infection. The patient may also experience pain or discomfort if the dialysate is too acidic, too cold or introduced too quickly, while diffuse pain with cloudy discharge may indicate an infection. Severe pain in the rectum or perineum can be the result of an improperly placed catheter. The dwell can also increase pressure on the diaphragm causing impaired breathing, and constipation can interfere with the ability of fluid to flow through the catheter. Chronic Complications Long term use of PD is associated with fibrosis of the peritoneum. A potentially fatal complication estimated to occur in roughly 2.5% of patients is encapsulating peritoneal sclerosis, in which the bowels become obstructed due to the growth of a thick layer of fibrin within the peritoneum. Other Other complications include low back pain and hernia or leaking fluid due to high pressure within the abdomen. Hypertriglyceridemia and obesity are also concerns due to the