Acute metabolic effects of dialysis fluids during CAPD.
Because the osmotic agents currently used for peritoneal dialysis, ie, glucose or amino acids, are also substrates, a metabolic transfer occurs during their peritoneal absorption. After the delivery of a 3.86% glucose dialysis solution, about 100% of the glucose absorbed through the peritoneal is oxidized. So, this glucose contributes fully to the energy load of the patients. Peritoneal glucose delivery also entertains hyperglycaemia and hyperinsulinaemia as compared to oral glucose. When compared to healthy subjects, oral glucose in continuous ambulatory peritoneal dialysis (CAPD) patients induces a higher glycaemic and insulinaemic response. This traduces insulin resistance in CAPD patients even after months of that renal replacement therapy. When amino acids are used in place of glucose in dialysis solution, they stimulate whole body protein turnover and are used mainly for protein synthesis. When a meal is coingested, protein breakdown is inhibited which reinforces the positive effect of the solution on protein balance.
Delarue
J
J
Laboratoire de Nutrition et Association Régionale d'Aide aux Urémiques du Centre Ouest, CHU de Tours, F-37044, France. gram01@club-internet.fr
Maingourd
C
C
D000284:Administration, Oral; D000596:Amino Acids / Q000378:metabolism / Q000494:pharmacology; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015314:Dialysis Solutions / Q000378:metabolism / Q000494:pharmacology*; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000097:blood; D010084:Oxidation-Reduction; D010531:Peritoneal Dialysis, Continuous Ambulatory
D000596:Amino Acids; D001786:Blood Glucose; D015314:Dialysis Solutions; D007328:Insulin; D005947:Glucose