Do diabetic patients receiving conventional dialysis solutions benefit from peritoneal dialysis?
OBJECTIVE
The study aimed to evaluate the impact of glucose-based peritoneal dialysis solutions (GBPDS) on diabetic patients on maintenance peritoneal dialysis.


METHODS
In this cross-sectional study we compared the influence of long term use of GBPDS on sixteen parameters related to the peritoneal glucose load, hydration status, inflammation, blood pressure, lipid profile and left ventricular mass in 45 stable PD patients (20 diabetic and 25 non-diabetic) receiving GBPDS.


RESULTS
At 24 months HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma BNP, hsCRP and IL-6 levels, WBC count, blood pressure, triglycerides, LDL-C and left ventricular mass index (LVMI) were higher in diabetic patients compared to non-diabetic subjects (P ≤ 0.04). Of 16 tested variables, 14 had deteriorated at 24 months in diabetic patients. PGLI values > 3 g/kg/day or FO > 1.0 L were associated with abnormal values of HbA1c, plasma BNP, CRP and plasma IL-6 levels. 60% of diabetic patients had PGLI > 3g/kg/day compared to 32% of non-diabetic patients (P < 0.001). Seventy per cent of diabetic patients had FO > 1.0 L compared to 28% of non-diabetic patients (P < 0.001). Only 12% of diabetic patients had nocturnal blood pressure dipping compared to 45% of non-diabetics (P = 0.03). 57.8% of the studied patients had increased LVMI. Diabetic patients had higher LVMI values compared to non-diabetics (P < 0.001). The presence of DM was found to be the most powerful predictor for the development of LVH (P < 0.001).


CONCLUSIONS
Utilization of GBPDS in diabetic PD patients may be associated with substantial adverse consequences affecting glycemic control, hydration status, lipid profile, inflammation, blood pressure control and LVM.
Faculty of Medicine in the Galilee, Bar‑Ilan University, Safed, Israel - drkamalh@hotmail.com.
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D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003929:Diabetic Neuropathies / Q000628:therapy*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*
D001786:Blood Glucose; D015314:Dialysis Solutions; D008055:Lipids; D005947:Glucose