New-onset hyperglycemia in nondiabetic chinese patients started on peritoneal dialysis.
BACKGROUND
Glucose has been used as the osmotic agent added to standard peritoneal dialysis (PD) solutions since its inception. Patients who have no history of glucose intolerance may develop hyperglycemia after the initiation of PD therapy. However, the prevalence and long-term implications of new-onset hyperglycemia in PD patients has not been studied.


METHODS
We studied 405 consecutive patients with renal failure newly started on PD therapy. Fasting plasma glucose levels 1 month after being stable on PD therapy were reviewed. Clinical factors affecting fasting plasma glucose levels were explored. Patients were followed up for 49.7 +/- 28.4 months.


RESULTS
Of 405 patients, 136 had underlying diabetic nephropathy and another 17 had preexisting diabetes before starting PD therapy. Of the remaining 252 patients, fasting plasma glucose levels were greater than 200 mg/dL (>11.1 mmol/L) in 21 (8.3%) and 126 to 200 mg/dL (7.0 to 11.1 mmol/L) in 48 patients (19.0%). Seven patients required insulin therapy, 3 required low-dose sulfonylurea therapy, and all other patients had glucose levels controlled by means of dietary restriction only. Fasting plasma glucose levels significantly correlated with patient age (Pearson r = 0.278; P < 0.001), Charlson comorbidity score (r = 0.484; P < 0.001), baseline serum C-reactive protein level (r = 0.390; P < 0.001), and serum albumin level (r = -0.182; P < 0.001). However, patients with new-onset hyperglycemia had similar values for body weight, body mass index, peritoneal transport parameters, and ultrafiltration profile compared with other patients. At 36 months, actuarial survival rates were 93.7%, 85.3%, 81.6%, and 66.7% for patients with fasting glucose levels less than 100, 100 to less than 126, 126 to less than 200, and 200 mg/dL or greater (5.6, 5.6 to <7.0, 7.0 to <11.1, and >or=11.1 mmol/L) and 65.9% for patients with preexisting diabetes, respectively (overall log rank test, P < 0.001).


CONCLUSIONS
New-onset hyperglycemia is common in patients without diabetes started on PD therapy. Contrary to common belief, obese patients do not appear to have a greater risk of hyperglycemia. Our results suggest that even mild hyperglycemia, with fasting plasma glucose level greater than 100 mg/dL (>5.6 mmol/L), is associated with worse survival in PD patients.
Szeto
Cheuk-Chun
CC
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. ccszeto@cuhk.edu.hk
Chow
Kai-Ming
KM
Kwan
Bonnie Ching-Ha
BC
Chung
Kwok-Yi
KY
Leung
Chi-Bon
CB
Li
Philip Kam-Tao
PK
D000328:Adult; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D051437:Renal Insufficiency / Q000097:blood / Q000208:ethnology* / Q000209:etiology / Q000628:therapy*
D001786:Blood Glucose