Benefit of glucose-free dialysis solutions on glucose and lipid metabolism in peritoneal dialysis patients.
BACKGROUND
Glucose absorbed from conventional peritoneal dialysis (PD) solutions contributes to unfavorable metabolic effects. Its replacement with a glucose-free osmotic agent such as icodextrin (ID) or amino acids (AA) may have some benefit on glucose and lipid metabolism.


METHODS
Serum lipids, insulin sensitivity and substrate oxidation (calorimetry) were measured before and after 8 weeks use of ID or AA in 22 patients. Calorimetry and blood tests (HbA1c, lipids) were also performed after 8 weeks of simultaneous use of ID and AA in 8 patients.


RESULTS
Cholesterol declined during the use of AA (4.8 +/- 0.3-4.5 +/- 0.3 mmol/l, p = 0.045). Triglycerides decreased during the use of both ID (2.2 +/- 0.2-1.9 +/- 0.1 mmol/l, p = 0.019) and AA (1.9 +/- 0.2-1.6 +/- 0.1 mmol/l, p = 0.024). Free fatty acids declined during the use of AA. There were no significant changes in insulin sensitivity. Glucose oxidation decreased and lipid oxidation increased during the use of ID, the changes in substrate oxidation were accentuated during the simultaneous use of ID and AA.


CONCLUSIONS
Replacement of glucose with ID or AA had a benefit on glucose and lipid metabolism.
Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
Terhi
T
Martikainen
Anna-Maija
AM
Teppo
Carola
C
Gronhagen-Riska
Agneta
A
Ekstrand
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000494:pharmacology; D003920:Diabetes Mellitus / Q000378:metabolism; D005260:Female; D005936:Glucans / Q000494:pharmacology; D005947:Glucose / Q000378:metabolism* / Q000494:pharmacology; D015312:Hemodialysis Solutions / Q000494:pharmacology*; D006801:Humans; D000077607:Icodextrin; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*
D000596:Amino Acids; D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose