Hepatic subcapsular steatosis as a complication associated with intraperitoneal insulin treatment in diabetic peritoneal dialysis patients.
OBJECTIVE
The aim of this study was to evaluate hepatic subcapsular steatosis (HSS) and its association with clinical parameters in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients and in diabetic CAPD patients receiving intraperitoneal (IP) or subcutaneous (SC) insulin.


METHODS
Cross-sectional study.


METHODS
A tertiary-care university hospital.


METHODS
28 CAPD patients (17 males and 11 females; mean age 53.5 +/- 14 years; mean CAPD duration 22.8 +/- 9 months) were included in the study. 14 patients had type II diabetes mellitus and 14 were nondiabetics. In the diabetic group, 8 patients were receiving IP insulin and 6 were receiving SC insulin.


METHODS
HSS was diagnosed on computed tomography without contrast administration. Other data collected were body mass index (BMI), weekly Kt/V, peritoneal equilibration test (PET) results, daily insulin dosage, duration of diabetes mellitus, duration of insulin treatment, dialysate glucose load, and serum findings for alanine aminotransferase, aspartate aminotransferase, albumin, and lipid profiles.


RESULTS
HSS was detected in 5 of the 8 diabetics who were receiving IP insulin. None of the diabetics receiving SC insulin and none of the nondiabetic patients exhibited HSS. Daily insulin dosage [108 (95 - 108.5) vs 54 (36 - 72) U/day, p = 0.02], BMI [31 (30.5 - 36) vs 26.6 (26 - 30) kg/m2, p = 0.02], serum triglyceride level [194 (184 - 505) vs 69 (61 - 82) mg/dL, p = 0.04], and PET creatinine levels [D/P2 creat: 0.67 (0.54 - 0.74) vs 0.50 (0.50 - 0.56), p = 0.05; D/P4 creat: 0.75 (0.64 - 0.86) vs 0.60 (0.59 - 0.62), p = 0.02] were higher in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS. PET glucose levels [D0/D2 glu: 0.40 (0.37 - 0.45) vs 0.50 (0.48 - 0.51), p = 0.03; D0/D4 glu: 0.36 (0.26 - 0.38) vs 0.44 (0.38 - 0.48), p = 0.04] were lower in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS.


CONCLUSIONS
Our results suggest that IP insulin plays a more important role in the pathogenesis of HSS than glucose levels in diabetic CAPD patients. They also indicate that HSS is associated with higher daily insulin requirement, obesity, hypertriglyceridemia, and high peritoneal transport rate in diabetic CAPD patients receiving IP insulin.
Torun
Dilek
D
Baskent University Faculty of Medicine, Department of Nephrology, Adana Teaching and Medical Research Center, Adana, Turkey. dilektorun@hotmail.com
Oguzkurt
Levent
L
Sezer
Siren
S
Zumrutdal
Aysegul
A
Singan
Metin
M
Adam
Fatma Ulku
FU
Ozdemir
Fatma Nurhan
FN
Haberal
Mehmet
M
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005234:Fatty Liver / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007274:Injections, Intraperitoneal; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase