Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis?

Abstract

N ew-onset diabetes and impaired glucose tolerance (IGT) have been shown to be associated with increased cardiovascular events and risk of death in the general population (1-3) and in patients undergoing dialysis (4-7). Since new-onset diabetes and IGT (NODI) is a common complication among patients on dialysis (4)(5)(6)8), it is important to explore the potential risk factors for this complication. However, published data on this issue are limited in dialysis populations.To our knowledge, traditional risk factors, such as age, male gender, obesity, hypertension, and hyperlipidemia, have been recognized to increase the risk for new-onset diabetes in the general population (9-11). These traditional factors, as well as uremia-related factors including malnutrition, inflammation, and comorbidities, have previously shown to be associated with new-onset diabetes, IGT, or fasting hyperglycemia in dialysis patients in 2 cross-sectional (4,8) and 2 longitudinal cohort datasets, respectively (6,7). However, the above parameters were collected at baseline or at a single timepoint in these studies, which makes it impossible to analyze the association between time-varying variables and outcomes. In addition, glucose is inevitably used as an osmotic agent in all commercial solutions for PD patients in China, accounting for about 20% of total energy intake (12,13). A previous study has indicated the potential side effects of dialysate glucose including a tendency for hyperglycemia and hyperinsulinemia in a dose-dependent manner in PD patients (14). However, 2 recent papers did not compare the higher risk for new-onset diabetes in PD populations with their hemodialysis (HD) counterpart (6,7). It is therefore of interest to explore the potential effect of the amount of dietary energy intake and glucose absorption via dialysate on the incidence of NODI in PD patients.All of the above mentioned contributors actually exist at the start of PD therapy and then vary to different degrees during follow-up. To determine the critical contributors to NODI, baseline characteristics and time-dependent variables need to be analyzed in Cox regression models. In this paper, we report a prospective cohort study to explore the incidence and risk factors for NODI, taking baseline and time-dependent covariates into account. METHODS SUBJECT SELECTIONAll the non-diabetic incident patients on chronic PD between August 2003 and August 2011 were enrolled in this This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at marketing@multi-med.com 278 DONG et al. MAY 2016 -VOL. 36, NO. 3 PDI study. All patients visited with a physician at least once every 3 months. All subjects began the PD program within 1 month after catheter implantation and were given lactate-buffered glucose dialysate with a twin-bag connection system (Baxter Healthcare, Guangzhou, China). This study was approved by the Medical Ethics Committee of Peking ...

New‐Onset Diabetes Mellitus in Peritoneal Dialysis and Hemodialysis Patients: Frequency, Risk Factors, and Prognosis—A Review

“…In the study by Dong et al advanced age was associated with increased risk of NODM in PD patients (21). Furthermore, in other clinical studies NODM in dialysis patients was linked with higher age (4,10,22).…”

“…Additionally, Szeto et al confirmed that FPG‐levels also significantly correlated with the age of PD patients . In two clinical studies obesity appeared to be an essential risk factor for new‐onset hyperglycemia in PD patients, which however, is in contrast to the study cohort of Szeto et al . Chronic inflammation is associated with NODM in both PD and HD patients.…”

“…However, only few data have been published on this issue in the dialysis population. In a retrospective study, dietary intake and daily dialysate glucose (DDG) content had no influence on NODM risk in PD patients, but body fat mass was a predictor for NODM .…”

“…Further, the Global Fluid Study reported NODM (glucose levels >11.1 mmol/L) in 3.7% of incident PD patients and in 5.4% of prevalent PD patients . Accordingly, Dong et al observed a 4.1% incidence of NODM in 621 PD patients .…”

Glükózterhelés a peritonealis dialízisben. Újabb elméleti megfontolások

“…Az aktív peritonealis dialízis mellett kialakuló szénhidráttolerancia-zavar (IGT vagy új diabetes) fokozott monitorozást igényel. A nóvum diabetes -egyes megfigyelések szerint -a kezdeti nagyobb BMI-vel, az inflammatorikus folyamatok aktivációjával (hsCRP) és az idősebb életkorral voltak kapcsolatba hozhatók [38].…”