The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis
Open Access
- 7 August 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Journal of Nephrology
- Vol. 34 (2), 503-519
- https://doi.org/10.1007/s40620-020-00804-2
Abstract
Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. 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 ‘osmo-metabolic’ 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.Keywords
This publication has 122 references indexed in Scilit:
- Hyperbranched Polyglycerol is an Efficacious and Biocompatible Novel Osmotic Agent in a Rodent Model of Peritoneal DialysisPeritoneal Dialysis International, 2013
- Xylitol prevents NEFA-induced insulin resistance in ratsDiabetologia, 2012
- Banting Lecture 2011Diabetes, 2011
- Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysisNephrology Dialysis Transplantation, 2011
- Icodextrin Increases Technique Survival Rate in Peritoneal Dialysis Patients with Diabetic Nephropathy by Improving Body Fluid ManagementClinical Journal of the American Society of Nephrology, 2011
- Ameliorating Hypertension and Insulin Resistance in Subjects at Increased Cardiovascular RiskHypertension, 2009
- Pressure Overload-Induced Cardiomyopathy in Heterozygous Carrier Mice of Carnitine Transporter Gene MutationHypertension, 2007
- Dialysate as FoodJournal of the American Society of Nephrology, 2005
- Glucose degradation products (GDP) retard remesothelialization independently of d-glucose concentrationKidney International, 2003
- Can the pentitol-hexitol theory explain the clinical observations made with xylitol?Medical Hypotheses, 2000