title: Peritoneal Dialysate Glucose Load and Systemic Glucose Metabolism in Non-Diabetics: Results from the GLOBAL Fluid Cohort Study.
abstract: OBJECTIVE
  Glucose control is a significant predictor of mortality in diabetic peritoneal dialysis (PD) patients. During PD, the local toxic effects of intra-peritoneal glucose are well recognized, but despite large amounts of glucose being absorbed, the systemic effects of this in non-diabetic patients are not clear. We sought to clarify whether dialysate glucose has an effect upon systemic glucose metabolism.
  
  
  METHODS
  We analysed the Global Fluid Study cohort, a prospective, observational cohort study initiated in 2002. A subset of 10 centres from 3 countries with high data quality were selected (368 incident and 272 prevalent non-diabetic patients), with multilevel, multivariable analysis of the reciprocal of random glucose levels, and a stratified-by-centre Cox survival analysis.
  
  
  RESULTS
  The median follow up was 5.6 and 6.4 years respectively in incident and prevalent patients. On multivariate analysis, serum glucose increased with age (β = -0.007, 95%CI -0.010, -0.004) and decreased with higher serum sodium (β = 0.002, 95%CI 0.0005, 0.003) in incident patients and increased with dialysate glucose (β = -0.0002, 95%CI -0.0004, -0.00006) in prevalent patients. Levels suggested undiagnosed diabetes in 5.4% of prevalent patients. Glucose levels predicted death in unadjusted analyses of both incident and prevalent groups but in an adjusted survival analysis they did not (for random glucose 6-10 compared with <6, Incident group HR 0.92, 95%CI 0.58, 1.46, Prevalent group HR 1.42, 95%CI 0.86, 2.34).
  
  
  CONCLUSIONS
  In prevalent non-diabetic patients, random glucose levels at a diabetic level are under-recognised and increase with dialysate glucose load. Random glucose levels predict mortality in unadjusted analyses, but this association has not been proven in adjusted analyses.
authors.affiliation: Institute of Applied Clinical Research, Keele University, Stoke on Trent, United Kingdom.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-6285-5368
authors.initials: M
authors.lastname: Lambie
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Heath Park, Cardiff, United Kingdom.|Renal Unit, Morriston Hospital, Swansea, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Chess
authors.affiliation: Division of Nephrology, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Do
authors.affiliation: Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, South Korea.
authors.forename: Hyunjin
authors.initials: H
authors.lastname: Noh
authors.affiliation: Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, South Korea.
authors.forename: Hi-Bahl
authors.initials: HB
authors.lastname: Lee
authors.affiliation: Division of Nephrology and Clinical Research Center for ESRD in Korea, Kyungpook National University Hospital, Daegu, South Korea.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Summers
authors.affiliation: Ipswich Hospital NHS Trust Ipswich Hospital, Heath Road, Ipswich, United Kingdom.
authors.forename: Paul Ford
authors.initials: PF
authors.lastname: Williams
authors.affiliation: Division of Nephrology and Immunology, University of Alberta, Edmonton, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Davison
authors.affiliation: Division of Nephrology, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, New Brunswick, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dorval
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Heath Park, Cardiff, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Topley
authors.affiliation: Institute of Applied Clinical Research, Keele University, Stoke on Trent, United Kingdom.
authors.forename: Simon John
authors.initials: SJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies
chemical_list: D005947:Glucose