Peritoneal dialysis (PD) patients are at high risk of developing cardiovascular disease, resulting from both traditional and nontraditional cardiovascular risk factors, including factors related to uremia and dialysis. Glucose metabolism is altered in chronic kidney disease patients even in the earlier stages and the most common manifestations are insulin resistance and dyslipidemia, known factors in the pathogenesis of hypertension and atherosclerosis. Exposure to high glucose concentration solutions during PD intensifies these metabolic abnormalities, which are extremely common in PD patients and potentially have an impact on cardiovascular outcome. Life style and dietary modification and pharmacological interventions may be particularly important to revert these risk factors and glucose sparing solutions may represent an additional strategy to change the PD-induced metabolic profile. Together, these approaches may have a positive impact in reducing the risk of mortality in PD patients.