{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:18:31Z","timestamp":1791501511677,"version":"4.3.4"},"reference-count":152,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T00:00:00Z","timestamp":1627257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Peritoneal dialysis (PD) is an important, if underprescribed, modality for the treatment of patients with end-stage kidney disease. Among the barriers to its wider use are the deleterious effects of currently commercially available glucose-based PD solutions on the morphological integrity and function of the peritoneal membrane due to fibrosis. This is primarily driven by hyperglycaemia due to its effects, through multiple cytokine and transcription factor signalling\u2014and their metabolic sequelae\u2014on the synthesis of collagen and other extracellular membrane components. In this review, we outline these interactions and explore how novel PD solution formulations are aimed at utilizing this knowledge to minimise the complications associated with fibrosis, while maintaining adequate rates of ultrafiltration across the peritoneal membrane and preservation of patient urinary volumes. We discuss the development of a new generation of reduced-glucose PD solutions that employ a variety of osmotically active constituents and highlight the biochemical rationale underlying optimization of oxidative metabolism within the peritoneal membrane. They are aimed at achieving optimal clinical outcomes and improving the whole-body metabolic profile of patients, particularly those who are glucose-intolerant, insulin-resistant, or diabetic, and for whom daily exposure to high doses of glucose is contraindicated.<\/jats:p>","DOI":"10.3390\/ijms22157955","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T09:25:52Z","timestamp":1627291552000},"page":"7955","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["How to Improve the Biocompatibility of Peritoneal Dialysis Solutions (without Jeopardizing the Patient\u2019s Health)"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8466-6314","authenticated-orcid":false,"given":"Mario","family":"Bonomini","sequence":"first","affiliation":[{"name":"Nephrology and Dialysis Unit, Department of Medicine, G. d\u2019Annunzio University, Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2341-2481","authenticated-orcid":false,"given":"Valentina","family":"Masola","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy"},{"name":"Department of Biomedical Sciences, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0043-7523","authenticated-orcid":false,"given":"Giuseppe","family":"Procino","sequence":"additional","affiliation":[{"name":"Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Zammit","sequence":"additional","affiliation":[{"name":"Translational & Experimental Medicine, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 C.","family":"Divino-Filho","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, CLINTEC, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arduino","family":"Arduini","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Iperboreal Pharma, 65100 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5733-2370","authenticated-orcid":false,"given":"Giovanni","family":"Gambaro","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s40258-018-00455-2","article-title":"Cost effectiveness of dialysis modalities: A systemic review of 723 economic evaluations","volume":"17","author":"Howell","year":"2019","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3238","DOI":"10.1681\/ASN.2016010112","article-title":"The Current State of Peritoneal Dialysis","volume":"27","author":"Mehrotra","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3389\/fphys.2018.01853","article-title":"Biocompatible peritoneal dialysis: The target is still way off","volume":"9","author":"Bartosova","year":"2019","journal-title":"Front. 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