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

Lindholm, Bengt, Barbari, Antoine, Allen, Jennifer, Dufour, Inès, Fraser, Donald ORCID: https://orcid.org/0000-0003-0102-9342, Heider, Annette, Kazancioglu, Rumeyza, Lichodziejewska-Niemierko, Monika, Malho-Guedes, Anabela, Neri, Loris, Parikova, Alena, Quevedo-Reina, Juan Carlos, Santana-Quintana, Adonay and Udayaraj, Udaya 2026. Clinical rationale behind glucose-sparing strategies in peritoneal dialysis: a narrative review. BMC Nephrology 10.1186/s12882-025-04732-w

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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.

Item Type:	Article
Date Type:	Publication
Status:	In Press
Schools:	Schools > Medicine
Publisher:	BioMed Central
ISSN:	1471-2369
Date of First Compliant Deposit:	19 January 2026
Date of Acceptance:	29 December 2025
Last Modified:	19 Jan 2026 13:15
URI:	https://orca.cardiff.ac.uk/id/eprint/184010

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