{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:18:58Z","timestamp":1791501538555,"version":"4.3.4"},"reference-count":141,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"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 a home-based efficacious modality for the replacement of renal function in end-stage kidney failure patients, but it is still under-prescribed. A major limitation is the durability of the dialytic technique. Continuous exposure of the peritoneum to bioincompatible conventional glucose-based solutions is thought to be the main cause of the long-term morpho-functional peritoneal changes that eventually result in ultrafiltration failure. Poor PD solution biocompatibility is primarily related to the high glucose content, which is not only detrimental to the peritoneal membrane but has many potential metabolic side effects. To improve the clinical outcome and prolong the survival of the treatment, PD-related bioincompatibility urgently needs to be overcome. However, combining dialytic and osmotic efficacy with a satisfactory biocompatible profile is proving to be quite difficult. New approaches targeting the composition of the PD solution include the replacement of glucose with other osmotic agents, and the addition of cytoprotective or osmo-metabolic compounds. Other strategies include the infusion of mesenchymal cells or the administration of orally active agents. In the present article, we review the current evidence on efforts to improve the biocompatible and functional performance of PD, focusing on studies performed in vivo (animal models of PD, human subjects on PD).<\/jats:p>","DOI":"10.3390\/ijms25063532","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T13:09:36Z","timestamp":1710940176000},"page":"3532","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge"],"prefix":"10.3390","volume":"25","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"}]},{"given":"Maria Pia","family":"Monaco","sequence":"additional","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"}]},{"given":"Vittorio","family":"Sirolli","sequence":"additional","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\/0000-0002-8912-5322","authenticated-orcid":false,"given":"Lorenzo","family":"Di Liberato","sequence":"additional","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\/0009-0000-0192-1723","authenticated-orcid":false,"given":"Tommaso","family":"Prosdocimi","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Iperboreal Pharma, 65100 Pescara, Italy"}],"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"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,20]]},"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. 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