L-carnitine: more than just an alternative to glucose as an osmotic agent for peritoneal dialysis?

Glucose toxicity remains a concern for long-term membrane function and metabolic side effects in peritoneal dialysis. Partial substitution of L-carnitine as an alternative but similarly effective osmotic agent is an attractive proposition, and, given once daily with glucose, it achieves equivalent ultrafiltration and plasma concentrations that are likely to be safe. The possibility that it can counter glucose-mediated injury to the aquaporin pathway, thus enhancing ultrafiltration, is an intriguing bonus that requires further study.