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Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects. This article reviews the efforts to develop alternative PD solutions that obviate some of these side effects, through the replacement of part of their glucose content with other osmolytes which are at least as efficient in removing fluids as glucose, but less impactful on patient metabolism. In particular, we will summarize clinical studies on the use of alternative osmotic ingredients that are commercially available (icodextrin and amino acids) and preclinical studies on alternative solutions under development (taurine, polyglycerol, carnitine and xylitol). In addition to the expected benefit of a glucose-sparing approach, we describe an \u2018osmo-metabolic\u2019 approach in formulating novel PD solutions, in which there is the possibility of exploiting the pharmaco-metabolic properties of some of the osmolytes to attenuate the systemic side effects due to glucose. This approach has the potential to ameliorate pre-existing co-morbidities, including insulin resistance and type-2 diabetes, which have a high prevalence in the dialysis population, including in PD patients.<\/jats:p>","DOI":"10.1007\/s40620-020-00804-2","type":"journal-article","created":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T06:03:03Z","timestamp":1596780183000},"page":"503-519","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8466-6314","authenticated-orcid":false,"given":"Mario","family":"Bonomini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Zammit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6705-9408","authenticated-orcid":false,"given":"Jos\u00e9 C.","family":"Divino-Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5127-4755","authenticated-orcid":false,"given":"Simon J.","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Di Liberato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arduino","family":"Arduini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-5368","authenticated-orcid":false,"given":"Mark","family":"Lambie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,7]]},"reference":[{"key":"804_CR1","doi-asserted-by":"publisher","first-page":"3238","DOI":"10.1681\/ASN.2016010112","volume":"27","author":"R Mehrotra","year":"2016","unstructured":"Mehrotra R, Devuyst O, Davies SJ, Johnson DW (2016) The current state of peritoneal dialysis. 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AA is an employee of CoreQuest. ML has received grant support from Baxter Healthcare, and speaker honoraria from Fresenius Medical Care and Baxter Healthcare. SD has received research funding from Baxter HealthCare and Fresenius Medical Care, speakers honoraria from Fresenius Medical Care, Advisory Board remuneration from Baxter Healthcare, ZytoProtec; SD, JCDF and ML have acted in an advisory capacity to CoreQuest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}