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

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.

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Publication Details

Journal
BMC Nephrology
Published
2026-01-13
DOI
https://doi.org/10.1186/s12882-025-04732-w
Primary Topic
Dialysis and Renal Disease Management
Type
article
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article

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

Rümeyza Kazancioğlu, Adonay Santana-Quintana, Alena Paříková, Inès Dufour et al.
BMC Nephrology
Dialysis and Renal Disease Management
article

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

Rümeyza Kazancioğlu, Adonay Santana-Quintana, Alena Paříková, Inès Dufour, Annette Heider, Donald Fraser, Loris Neri, Udaya Udayaraj, Monika Lichodziejewska-Niemierko, Anabela Malho-Guedes, Jennifer Allen, Antoine Barbari, Bengt Lindholm, Juan Carlos Quevedo-Reina
article en

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.

BMC NephrologyVol. 27(1)
Cliniques Universitaires Saint-Luc (BE), Nottingham University Hospitals NHS Trust (GB), Karolinska University Hospital (SE), Lebanese University (LB), Churchill Hospital (GB), Bezmiâlem Vakıf Üniversitesi (TR), University of Oxford (GB), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Bionorica (Germany) (DE), Algarve Biomedical Center (PT), Institute of Clinical and Experimental Medicine (CZ), Ospedale San Pietro Fatebenefratelli (IT), University of Algarve (PT), Gdańsk Medical University (PL), University of Wales (GB)
Clean water and sanitation
Openalex Percentile: Top 91%
Dialysis and Renal Disease Management
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