Solutes transport characteristics in peritoneal dialysis: variations in glucose and insulin serum levels.
BACKGROUND
Differences in small solutes transport rate (SSTR) during peritoneal dialysis (PD) may affect water and solutes removal. Patients with high SSTR must rely on shorter dwell times and increased dialysate glucose concentrations to keep fluid balance. Glucose absorption during peritoneal dialysis (PD), besides affecting glucose and insulin metabolism, may induce weight gain. The study aimed at examining acute glucose and insulin serum level changes and other potential relationships in PD patients with diverse SSTR.


METHODS
This cross-sectional study used a modified peritoneal equilibration test (PET) that enrolled 34 prevalent PD patients. Zero, 15, 30, 60, 120, 180, and 240-minute glucose and insulin serum levels were measured. Insulin resistance index was assessed by the homeostasis model assessment (HOMA-IR) formula. SSTR categories were classified by quartiles of the four-hour dialysate/serum creatinine ratio (D(4)/P(Cr)). Demographic and clinical variables were evaluated, and the body mass index (BMI) was estimated. Correlations among variables of interest and categories of SSTR were explored.


RESULTS
Glucose serum levels were significantly different at 15, 30, and 60 minutes between high and low SSTR categories (p = 0.014, 0.009, and 0.022). Increased BMI (25.5 +/- 5.1) and insulin resistance [HOMA-IR = 2.60 (1.40-4.23)] were evidenced overall. Very strong to moderate correlations between insulin levels along the PET and HOMA-IR (r = 0.973, 0.834, 0.766, 0.728, 0.843, 0.857, 0.882) and BMI (r = 0.562, 0.459, 0.417, 0.370, 0.508, 0.514, 0.483) were disclosed. CONCLUSIONS; Early glucose serum levels were associated with SSTR during a PET. Overweight or obesity and insulin resistance were prevalent. An association between insulin serum levels and BMI was demonstrated.
da Silva
Dirceu R
DR
Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Faculdade de Medicina/IPB/HSL, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Figueiredo
Ana E
AE
Antonello
Ivan C
IC
Poli de Figueiredo
Carlos E
CE
d'Avila
Domingos O
DO
D000328:Adult; D000368:Aged; D001692:Biological Transport; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009997:Osmotic Pressure; D010316:Particle Size; D010530:Peritoneal Dialysis / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
D015415:Biomarkers; D001786:Blood Glucose; D015314:Dialysis Solutions; D007328:Insulin