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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.

The first dialysis treatment in Sweden of a patient with acute kidney failure was performed already in 1946 by the pioneer Nils Alwall in Lund. Since then, there has been a tremendous development in the practice of nephrology in Sweden. The first kidney transplant was performed in 1964, and during the following decades, dialysis and nephrology departments emerged in all regions of the country. Today, Sweden has 10 million inhabitants and about 10,000 patients on renal replacement therapy, corresponding to a prevalence of 1000 pmp, out of which about 60% have a functioning transplant. A vast majority is treated in public hospitals. Sweden has about 300 nephrologists, making up less than 1% of the physicians in the country. About 1100 patients start renal replacement therapy yearly corresponding to an incidence rate of 120 pmp, diabetes being the most common primary cause of uremia, although end-stage renal disease caused by type 1 diabetes is decreasing. The yearly incident rate has levelled off and now seems to decrease which may be attributed to an improved care of patients with chronic kidney disease.

Nephrology was organized as a medical discipline in the early years of the twentieth century. It is both a medical specialty and an organized global health sector, responsible for millions of stakeholders worldwide. This introductory chapter goes beyond concepts and data, addressing the initiative behind the “Nephrology Worldwide” book in all its spheres: the vision, the project, and the mission. We also curated a selection of nephrology highlights in the countries from local nephrologists’ view. Finally, we summarize our vision on education and future perspectives for nephrology.