title: Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials.
abstract: BACKGROUND
  Glucose, the conventional osmotic agent in peritoneal dialysis (PD) solutions, may contribute to atherogenic dyslipoproteinemia and increased cardiovascular risk.
  
  
  OBJECTIVE
  To determine whether a low-glucose PD regimen may improve the serum lipid and lipoprotein profile in patients with diabetes.
  
  
  METHODS
  A prospective, open-label, parallel group, multinational, randomized, controlled trial with a 6-month follow-up, comprising 251 patients with diabetes receiving PD. Patients were randomized to a low-glucose PD regimen (dextrose-based PD solution plus icodextrin, a starch polymer, and amino acids) or a conventional PD regimen (dextrose PD solutions). Serum lipid and apolipoprotein profiles were determined at baseline and 3 and 6 months.
  
  
  RESULTS
  Serum triglycerides, very low-density-lipoprotein cholesterol, and apolipoprotein B (apoB) decreased significantly in the intervention group at both 3 and 6 months compared with baseline (serum triglycerides: median change at 3 months -0.5 mmol/L, P < .001, at 6 months -0.3 mmol/L, P < .001; very low-density-lipoprotein cholesterol: -0.3 mg/dL, P < .001; -0.3 mg/dL, P < .001; and apoB: -8.5 mg/dL, P < .001; -3.6 mg/dL, P = .043, respectively) and also compared with the control group. In contrast, apoB levels increased significantly in the control group at 3 and 6 months compared with baseline (5.3 mg/dL, P = .041; 5.2 mg/dL, P = .007, respectively). Percentage of patients on lipid-lowering medications at baseline and intensity of therapy was equivalent in each group. The apoB decrease was not affected by lipid-lowering medications in the intervention group.
  
  
  CONCLUSIONS
  A low glucose-PD regimen significantly improved the atherogenic lipoprotein phenotype compared with PD patients treated with a conventional glucose regimen.
authors.affiliation: McGill University Health Centre, McGill University, Montreal, Canada. Electronic address: allansniderman@hotmail.com.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Sniderman
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Sloand
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
authors.forename: Philip K T
authors.initials: PK
authors.lastname: Li
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Story
authors.affiliation: University Health Network and University of Toronto, Toronto, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
mesh_terms: D000328:Adult; D000368:Aged; D001053:Apolipoproteins / Q000097:blood; D050197:Atherosclerosis / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000628:therapy*; D050171:Dyslipidemias / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D001053:Apolipoproteins; D008055:Lipids; D005947:Glucose
keywords: Diabetes; Lipid metabolism; Lipoproteins; Low glucose dialysis; Peritoneal dialysis