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

## TL;DR

This review discusses why reducing glucose use in peritoneal dialysis is important to avoid health risks and how alternative solutions might help.

## Contribution

The paper provides a clinical rationale for using glucose-sparing strategies in peritoneal dialysis to mitigate metabolic and peritoneal damage.

## Key findings

- Glucose-based dialysis solutions can damage the peritoneal membrane and cause metabolic issues.
- Alternative osmotic agents like icodextrin and amino acids may reduce these harmful effects.
- Glucose-sparing strategies could improve clinical outcomes for dialysis patients.

## 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.