Comparisons of the Peritoneal Equilibration Test and Ultrafiltration in Patients with and without Diabetes Mellitus on Continuous Ambulatory Peritoneal Dialysis

Abstract

Background/Aims: To compare dialysance and ultrafiltration (UF) of peritoneum in diabetes mellitus (DM) and non-DM patients on continuous ambulatory peritoneal dialysis. Methods: A total of 162 adult patients on continuous ambulatory peritoneal dialysis (40 DM and 122 non-DM patients) were studied with the peritoneal equilibration test (PET) using 2.5% glucose dialysis solution retained for 4 h. Patients using 2,000 or 1,500 ml of infusion volume were classified into groups A (23 DM and 63 non-DM patients) and B (16 DM and 41 non-DM patients), respectively. PET results were compared between DM and non-DM patients by unpaired t test. Using Pearson’s correlation and least-square multiple regression, the most powerful predictors of UF rate were also evaluated in DM and non-DM patients. Results: There were no differences between PET parameters and UF rate between DM and non-DM patients in the whole group (WG) and group A. The only significant difference (p < 0.05) was an increased D4/D0 value in DM patients in group B. The most simple but powerful method to predict UF rate was (100 – GAP)/(D4/D0), where GAP corresponds to the glucose absorption percentage and D4/D0 is the PET 4-hour dialysate glucose level/PET 0-hour dialysate glucose level. GAP and D4/D0 were two major determinants of UF rate in the DM group, non-DM group and WG. Conclusions: Peritoneal permeability did not differ between DM and non-DM patients, and GAP and D4/D0 were two major factors predicting UF rate.

Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

“…Some groups have detected faster transport rates in diabetics [21,22,23,24], while others have not observed differences with nondiabetics [12,18,25]. On the other hand, studies comparing peritoneal water transport characteristics in these 2 groups are remarkably scarce.…”

“…On the other hand, studies comparing peritoneal water transport characteristics in these 2 groups are remarkably scarce. Chou et al [12] did not detect a difference in the capacity of UF of 40 diabetics and 122 nondiabetics, either incident or prevalent on PD. However, the authors estimated this parameter using the classic 2.27/2.5% glucose-based PET, which may not be accurate for this purpose.…”

“…How these factors perform in the specific case of diabetics is another controversial issue. Previous studies comparing the characteristics of peritoneal transport in diabetics and nondiabetics are surprisingly scarce, and have yielded conflicting results [12,13]. In particular, few studies have investigated the time course of peritoneal function, and more specifically of water transport, in these patients.…”

Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis. A Longitudinal Study

“…Several studies have compared small solute transport characteristics in diabetic and nondiabetic patients undergoing PD, with conflicting results. Some groups have detected faster transport rates in diabetics [21][22][23][24], while others have not observed differences with nondiabetics [12,18,25]. On the other hand, studies comparing peritoneal water transport characteristics in these 2 groups are remarkably scarce.…”

Diabetes Influences Peritoneal Morphology in Uremic Patients at the Initiation of Peritoneal Dialysis

“…However, few studies have evaluated morphologic changes in diabetic patients (4,5). Additionally, whether peritoneal permeability differs between diabetic patients and diabetes-free patients has not been established clinically (11)(12)(13)(14)(15)(16). Thus, we examined morphologic changes of the peritoneum at the start of PD in diabetic patients with renal failure and compared the results with results in diabetes-free patients with renal failure.…”