Clinical rationale behind glucose-sparing strategies in peritoneal dialysis: a narrative review
Year: 2026
Type: review
Abstract: 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.
Source: BMC Nephrology
Institutions: Karolinska University Hospital, Karolinska Institutet, Lebanese University, Nottingham University Hospitals NHS Trust, Cliniques Universitaires Saint-Luc, Cardiff University, Bezmiâlem Vakıf Üniversitesi, Bezmiâlem Vakıf Üniversitesi Hastanesi, Gdańsk Medical University, Unidade Local de Saúde do Algarve, Ospedale Michele e Pietro Ferrero - Verduno, Institute of Clinical and Experimental Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, Churchill Hospital, University of Oxford
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
Funder: Karolinska Institutet
OpenAlex ID: W7123355136