Reducing cardiometabolic risk in peritoneal dialysis patients: role of the dialysis solution.
Peritoneal dialysis (PD) is a well-established form of therapy for stage 5 chronic kidney disease requiring renal replacement therapy. D-Glucose has been used successfully for several decades as the osmotic agent employed in dialysis solutions to achieve adequate fluid removal. The absorption of 100-200 grams of glucose per day has been suggested as potentially increasing cardiometabolic risk, particularly in patients with diabetes. Supporting and undermining evidence for this hypothesis is reviewed, with a focus on the role of glucose absorption in changes in body composition, dyslipidemia, and glycemic control in diabetic PD patients. Clinical strategies to optimize fluid removal while minimizing the metabolic impact of glucose absorption are also discussed.
Holmes
Clifford J
CJ
Renal Division, Baxter Healthcare, McGaw Park, Illinois 60085, USA. cliff_holmes@baxter.com
D054392:Adipokines / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015314:Dialysis Solutions / Q000009:adverse effects* / Q000378:metabolism; D050171:Dyslipidemias / Q000097:blood / Q000209:etiology; D019317:Evidence-Based Medicine; D005947:Glucose / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D050152:Intra-Abdominal Fat / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015430:Weight Gain
D054392:Adipokines; D001786:Blood Glucose; D015314:Dialysis Solutions; D005947:Glucose