Narrative Review of Glycemic Management in People With Diabetes on Peritoneal Dialysis

Wijewickrama, Piyumi; Williams, Jennifer; Lambie, Mark; Baín, Steve; Dasgupta, Indranil; Chowdhury, Tahseen A; Wahba, Mona; Frankel, Andrew; Karalliedde, Janaka

doi:10.1016/j.ekir.2023.01.040

Cited by 5 publications

(4 citation statements)

References 101 publications

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“…A recent review highlighted the need for an integrated approach to managing diabetes in people with PD and the need for specific standards of care for this unique cohort of people at high risk of glycaemic variability, hypoglycaemia and fragmented diabetes care. 19 When considering the follow-up and screening of people with diabetes who did not have KF, a meta-analysis in 2018 reported a diabetic retinopathy screening uptake of between 61% and 89%. 20 Authors from the United States report that 63% of people with diabetes had received an annual foot check, while more recent Canadian data from 2022 showed that 53% had undergone an annual foot examination by a healthcare provider.…”

Section: Discussionmentioning

confidence: 99%

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Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit

Wijewickrama,

Onyema,

Eid

et al. 2023

Perit Dial Int

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There is limited data on the standards of diabetes care in people on peritoneal dialysis (PD). Our aim was to assess the standards of diabetes care and the burden of hypoglycaemia in people with diabetes on PD. We performed a retrospective study at three university hospitals from December 2021 to January 2022. Clinical data were extracted from electronic health records. Diabetes care of people on PD was compared against recommended standards for people with diabetes on haemodialysis (as there are no agreed standards for PD). The degree of hypoglycaemia awareness was assessed by validated questionnaires. A total of 65 adults (15 type 1, 49 type 2 and 1 monogenic-diabetes) with a mean age of 63 (range 29–88) years were evaluated. Of them, 92% had diabetes retinal screening with annual review. In contrast, in this high-risk group for foot disease, only 77% had annual foot reviews. The rates of diabetes specialist reviews were variable between hospitals at 63–94% and 10 (15%) had impaired hypoglycaemia awareness. Of the cohort, 32% had HbA1c within the acceptable range of 58–80 mmol/mol (7.5–8.5%), 21% had HbA1c below 58 mmol/mol (7.5%) and 21% ( n = 14) reported at least one hypoglycaemic event per month. Our results indicate variation of care within and between different centres, and the need for improved diabetes care in people on PD. Further work is required to establish agreed standards/recommendations of diabetes care in this population. Our findings highlight the necessity of an integrated multidisciplinary approach to improve the standard of diabetes care for people on PD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit

Wijewickrama,

Onyema,

Eid

et al. 2023

Perit Dial Int

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“…8 As a result, maintaining glycaemic control during PD is particularly challenging for patients with DM. 9 Modifications to PDFs have been made in an attempt to improve the efficiency and sustainability of PD, including the addition of cytoprotective agents and replacement of glucose with other osmotic agents. 7 Rare sugars occur in very small quantities in nature, and approximately 50 types of rare sugars are naturally present.…”

Section: Introductionmentioning

confidence: 99%

“…8 As a result, maintaining glycaemic control during PD is particularly challenging for patients with DM. 9…”

Section: Introductionmentioning

confidence: 99%

Partial replacement of d-glucose with d-allose ameliorates peritoneal injury and hyperglycaemia induced by peritoneal dialysis fluid in rats

et al. 2023

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Background: Peritoneal dialysis (PD) is a crucial dialysis method for treating end-stage kidney disease. However, its use is restricted due to high glucose-induced peritoneal injury and hyperglycaemia, particularly in patients with diabetes mellitus. In this study, we investigated whether partially replacing d-glucose with the rare sugar d-allose could ameliorate peritoneal injury and hyperglycaemia induced by peritoneal dialysis fluid (PDF). Methods: Rat peritoneal mesothelial cells (RPMCs) were exposed to a medium containing d-glucose or d-glucose partially replaced with different concentrations of d-allose. Cell viability, oxidative stress and cytokine production were evaluated. Sprague–Dawley (SD) rats were administrated saline, a PDF containing 4% d-glucose (PDF-G4.0%) or a PDF containing 3.6% d-glucose and 0.4% d-allose (PDF-G3.6%/A0.4%) once a day for 4 weeks. Peritoneal injury and PD efficiency were assessed using immuno-histological staining and peritoneal equilibration test, respectively. Blood glucose levels were measured over 120 min following a single injection of saline or PDFs to 24-h fasted SD rats. Results: In RPMCs, the partial replacement of d-glucose with d-allose increased cell viability and decreased oxidative stress and cytokine production compared to d-glucose alone. Despite the PDF-G3.6%/A0.4% having a lower d-glucose concentration compared to PDF-G4.0%, there were no significant changes in osmolality. When administered to SD rats, the PDF-G3.6%/A0.4% suppressed the elevation of peritoneal thickness and blood d-glucose levels induced by PDF-G4.0%, without impacting PD efficiency. Conclusions: Partial replacement of d-glucose with d-allose ameliorated peritoneal injury and hyperglycaemia induced by high concentration of d-glucose in PDF, indicating that d-allose could be a potential treatment option in PD.

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Peritoneal Dialysis

Punzalan

2024

Renal Nursing

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Narrative Review of Glycemic Management in People With Diabetes on Peritoneal Dialysis

Cited by 5 publications

References 101 publications

Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit

Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit

Partial replacement of d-glucose with d-allose ameliorates peritoneal injury and hyperglycaemia induced by peritoneal dialysis fluid in rats

Peritoneal Dialysis

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