Therapeutic potential of amino acid-based peritoneal dialysis solutions: a systematic review

Peritoneal dialysis (PD) offers many advantages over hemodialysis but chronic exposure to bio-incompatible glucose-based PD solutions and continuous absorption of glucose from the dialysate may lead to peritoneal membrane (PM) dysfunction and systemic metabolic complications such as hyperglycemia, insulin resistance, dyslipidemia, and obesity. Replacing one daily exchange of 1.36% glucose-based solution with one 1.1% amino acid-based PD solution may provide nutritional benefits of amino acid supplementation, improve biocompatibility, and reduce the peritoneal glucose load while maintaining similar ultrafiltration and solute removal capacity. Randomized clinical trials and mechanistic studies show beneficial effects of amino acid-based PD solutions on peritoneal homeostasis, preserved viability of the PM, and favorable nutritional and metabolic effects. This systematic review highlights the clinical rationale for implementing use of amino acid-based PD solutions as an integral part of glucose-sparing strategies in PD to reduce the cumulative intraperitoneal glucose load and mitigate its well-documented adverse effects. Amino acid-based PD solutions emerge as a clinically viable, glucose-free alternative and a nutritionally beneficial option that can improve the nutritional status of PD patients by providing essential amino acids when used as part of a comprehensive glucose-sparing strategy. Targeted use of these solutions, particularly in malnourished or high-risk patients, represents a personalized approach to optimizing peritoneal dialysis outcomes.Clinical trial number: Not applicable.