title: The Association Between Glucose Exposure and the Risk of Peritonitis in Peritoneal Dialysis Patients.
abstract: ♦
  
  
  OBJECTIVE
  Little or no clinical evidence is available on the association between glucose exposure and peritoneal host defense in peritoneal dialysis (PD) patients. The objective of the present study was to quantify the exposure to glucose during the first year on PD and investigate the association with subsequent peritonitis. ♦
  
  
  METHODS
  We analyzed prospectively collected demographic and peritonitis data from incident adult PD patients between 1990 and 2010. For the present study, we conducted a review of both in- and outpatient medical records of all patients to obtain their day-to-day dialysis schemes during the first year on PD. From these data, the average exposure to glucose was quantified. The exposure was stratified into low- and high-glucose groups based on the median, analyzed per standard deviation and in quartiles. Cox proportional hazard models were used to calculate crude and adjusted hazard ratios (HRs) and 95% confidence intervals for the association between glucose exposure and peritonitis. Adjustments were made for age, sex, primary kidney disease, diabetes mellitus, Davies comorbidity score and the treatment period. ♦
  
  
  RESULTS
  In total, 230 patients were included in the study of whom 151 (66%) experienced a first peritonitis episode. The median follow-up time was 2.6 years (interquartile range [IQR]: 1.9 - 3.8) in the low-glucose group and 3.1 (IQR: 2.1 - 4.2) in the high-glucose group. After adjustment for confounding factors, no association between high glucose exposure and the risk of peritonitis was found (HR: 0.81; 0.55 - 1.17). No association was present when glucose exposure was analyzed per standard deviation (SD) (HR: 0.98; 0.79 - 1.21) or patient quartiles were applied. No association was identified between glucose exposure and severe peritonitis, Staphylococcus aureus peritonitis, or a peritonitis episode that lasted more than 14 days. ♦
  
  
  CONCLUSIONS
  Exposure to glucose is not associated with an increased risk of peritonitis. The equilibrium between glycemic harm to peritoneal host defense and detrimental effects of glucose on invading microorganisms may determine the susceptibility to peritoneal infection.
authors.affiliation: Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands a.t.vandiepen@amc.uva.nl.
authors.forename: Anouk T N
authors.initials: AT
authors.lastname: van Diepen
authors.affiliation: St. Elisabeth Hospital, Department of Nephrology and Internal Medicine, Tilburg, The Netherlands.
authors.forename: Sadie
authors.initials: S
authors.lastname: van Esch
authors.affiliation: Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Dianet, Amsterdam-Utrecht, The Netherlands.
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Struijk
authors.affiliation: Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005947:Glucose
keywords: Peritoneal dialysis; glucose exposure; host defense; peritonitis