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Peritoneal dialysis (PD) is a critical renal replacement therapy for end-stage kidney disease. However, its adoption remains limited, partly due to peritoneal fibrosis and metabolic complications induced by conventional glucose-based peritoneal dialysis fluid (PDF), the primary complications in PD patients and the leading cause of technique failure. This review outlines three innovative approaches to overcome these limitations: (1) novel biocompatible osmotic agents (L-carnitine can improve the metabolism of the peritoneum, and hyperbranched polyglycerol provides sustained ultrafiltration with dual peritoneal/renal protection), (2) advanced biocompatible buffers (citrate and pyruvate), and (3) peritoneal protectants (glycosaminoglycans and molecular hydrogen) that collectively mitigate fibrosis while protecting membrane function. These developments indicate a future direction for biocompatible PDF: integrating dual or triple protective functions of "osmotic agents + buffers + additives" synergy-optimizing hybrid formulations and accelerating clinical translation. Furthermore, we explored the emerging role of PD in refractory heart failure, where specialized PDF and steady-concentration protocols enhanced ultrafiltration efficiency. These advances address volume overload in cardiorenal syndrome, expanding PD's therapeutic scope of PD to systemic conditions such as heart failure.
Xu et al. (Mon,) studied this question.