Acute central haemodynamic effects induced by intraperitoneal glucose instillation.
BACKGROUND
The supposed lack of a haemodynamic impact of peritoneal dialysis (PD) has been challenged recently by the finding of a mild increase of peripheral blood pressure (BP) during an acute dwell. It is not clear whether, besides the effect of changes in intraperitoneal (IP) volume and/or pressure, IP glucose instillation and absorption plays a role in this. Therefore, we tested the impact of IP instillation of glucose on the evolution of central haemodynamic parameters, using SphygmoCor, during an acute dwell with two different glucose concentrations.


METHODS
Stable, non-diabetic PD patients (N = 22) were treated consecutively in a randomized, cross-over design (A then B or B then A) with one 1.36% (A) and one 3.86% (B) physioneal dwell of 100 min. Central BP was measured with SphygmoCor and blood was sampled for serum glucose and insulin levels every 20 min. Insulin resistance was defined as a Homeostatic Model Assessment Index (HOMA-index) >1.4.


RESULTS
Serum glucose levels rose during both the 1.36% and the 3.86% dwell, whereas insulin levels rose only during the 3.86% dwell. The increase of both glucose and insulin levels was more pronounced in patients with insulin resistance (11/22 patients). There was, however, no accompanying change versus baseline in haemodynamic parameters (carotid systolic blood pressure, diastolic BP, heart rate or augmentation index).


CONCLUSIONS
Despite substantial increases in blood glucose and insulin levels, there was no accompanying change in central haemodynamic parameters during an acute PD dwell with low or high glucose concentrations.
Pletinck
Anneleen
A
Renal Division, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium.
Verbeke
Francis
F
Van Bortel
Luc
L
Dequidt
Clement
C
Vijt
Denise
D
Van Biesen
Wim
W
Vanholder
Raymond
R
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006439:Hemodynamics; D006801:Humans; D007328:Insulin / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods
D001786:Blood Glucose; D007328:Insulin; D005947:Glucose