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<p>The effectiveness of peritoneal dialysis (PD) relies on dialysate-induced solute and water transport across the peritoneal membrane, facilitated by concentration and type of osmotic agents. Standard PD solutions predominantly use glucose as an osmotic agent due to its well-known metabolism, effective ultrafiltration during shorter dwells, and low cost. However, glucose exposure may damage the structure and function of the peritoneal membrane and cause systemic metabolic complications, including insulin resistance and cardiovascular disease, underscoring the need for glucose-sparing strategies with alternative solutions, such as solutions with icodextrin and amino acids as osmotic agents, and glucose-based, less bioincompatible fluids with physiological pH and reduced glucose degradation products. This brief narrative review examines the unwanted effects of glucose-based solutions and the clinical rationales behind glucose-sparing strategies that may reduce these effects and potentially improve clinical outcomes.</p>

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Clinical rationale behind glucose-sparing strategies in peritoneal dialysis: a narrative review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月13日

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  • Bengt Lindholm,
  • Antoine Barbari,
  • Jennifer Allen,
  • Inès Dufour,
  • Donald Fraser,
  • Annette Heider,
  • Rumeyza Kazancioglu,
  • Monika Lichodziejewska-Niemierko,
  • Anabela Malho-Guedes,
  • Loris Neri,
  • Alena Parikova,
  • Juan Carlos Quevedo-Reina,
  • Adonay Santana-Quintana,
  • Udaya Udayaraj

摘要

The effectiveness of peritoneal dialysis (PD) relies on dialysate-induced solute and water transport across the peritoneal membrane, facilitated by concentration and type of osmotic agents. Standard PD solutions predominantly use glucose as an osmotic agent due to its well-known metabolism, effective ultrafiltration during shorter dwells, and low cost. However, glucose exposure may damage the structure and function of the peritoneal membrane and cause systemic metabolic complications, including insulin resistance and cardiovascular disease, underscoring the need for glucose-sparing strategies with alternative solutions, such as solutions with icodextrin and amino acids as osmotic agents, and glucose-based, less bioincompatible fluids with physiological pH and reduced glucose degradation products. This brief narrative review examines the unwanted effects of glucose-based solutions and the clinical rationales behind glucose-sparing strategies that may reduce these effects and potentially improve clinical outcomes.