Effects of oral glucose on intermediary metabolism in continuous ambulatory peritoneal dialysis patients versus healthy subjects.
OBJECTIVE
To explore the mechanisms and metabolic consequences of the insulin resistance of patients treated by continuous ambulatory peritoneal dialysis (CAPD).


METHODS
CAPD patients and healthy subjects ingested a similar mean oral glucose load per kilogram of fat-free mass (FFM) [1.20+/-0.03 g/(kg FFM) vs 1.20+/-0.06 g/(kg FFM); CAPD vs healthy subjects]. Substrate oxidation was monitored over 6 hours using indirect calorimetry.


METHODS
Peritoneal dialysis unit of a tertiary-care institutional center.


METHODS
Glycemia, insulinemia, substrate oxidation.


METHODS
Six CAPD patients (68+/-5 yr) and 6 healthy subjects (24+/-1 yr). The CAPD patients had similar body mass index (21.4+/-1.3 vs 22.9+/-1.1 kg/m2), a higher percent fat (25.8%+/-3.7% vs 16%+/-2.2%; p < 0.05), and a lower FFM (42.2+/-2.2 kg vs 56.5+/-2.6 kg; p < 0.01) than healthy subjects.


RESULTS
The CAPD patients displayed a higher glycemic and insulinemic responses to glucose than did healthy subjects (p < 0.05), but similar glucose oxidation and storage. Lipid oxidation and plasma nonesterified fatty acids were not increased in CAPD patients versus healthy subjects, in spite of a higher adiposity. Fat oxidation was related to fat mass in CAPD patients (r2 = 0.77, p < 0.05) but not in healthy subjects (r2 = 0.05).


CONCLUSIONS
CAPD patients display an insulin-resistance not explained by an increased lipid oxidation. The maintenance of intracellular glucose utilization at the expense of higher glycemic and insulinemic responses suggests a defective glucose transport.
Delarue
J
J
Clinique Médicale A et Laboratoire de Nutrition, Unité de Recherche Associée Lipides et Croissance, Hôpital Bretonneau, Tours, France.
Maingourd
C
C
Couet
C
C
Vidal
S
S
Bagros
P
P
Lamisse
F
F
D000368:Aged; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D004734:Energy Metabolism; D005260:Female; D005947:Glucose / Q000493:pharmacokinetics / Q000494:pharmacology*; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy; D008297:Male; D010084:Oxidation-Reduction; D010531:Peritoneal Dialysis, Continuous Ambulatory
D005947:Glucose