Solutes Transport Characteristics in Peritoneal Dialysis: Variations in Glucose and Insulin Serum Levels

Abstract

Background. Differences in small solutes transport rate (SSTR) during peritoneal dialysis (PD) may affect water and solutes removal. Patients with high SSTR must rely on shorter dwell times and increased dialysate glucose concentrations to keep fluid balance. Glucose absorption during peritoneal dialysis (PD), besides affecting glucose and insulin metabolism, may induce weight gain. The study aimed at examining acute glucose and insulin serum level changes and other potential relationships in PD patients with diverse SSTR. Methods. This crosssectional study used a modified peritoneal equilibration test (PET) that enrolled 34 prevalent PD patients. Zero,15, 30, 60, 120, 180, and 240-minute glucose and insulin serum levels were measured. Insulin resistance index was assessed by the homeostasis model assessment (HOMA-IR) formula. SSTR categories were classified by quartiles of the four-hour dialysate/serum creatinine ratio (D 4 /P Cr ). Demographic and clinical variables were evaluated, and the body mass index (BMI) was estimated. Correlations among variables of interest and categories of SSTR were explored. Results. Glucose serum levels were significantly different at 15, 30, and 60 minutes between high and low SSTR categories (p = 0.014, 0.009, and 0.022). Increased BMI (25.5 ± 5.1) and insulin resistance [HOMA-IR = 2.60 (1.40-4.23)] were evidenced overall. Very strong to moderate correlations between insulin levels along the 0.834, 0.766, 0.728, 0.843, 0.857, 0.882) and BMI (r = 0.562, 0.459, 0.417, 0.370, 0.508, 0.514, 0.483) were disclosed. Conclusions. Early glucose serum levels were associated with SSTR during a PET. Overweight or obesity and insulin resistance were prevalent. An association between insulin serum levels and BMI was demonstrated.

Nutritional Management of End-Stage Renal Disease Patients Treated with Peritoneal Dialysis

“…EFFECTS Glucose absorption is associated with hyperinsulinemia and may lead to weight gain [37]. Studies suggest that the increase in weight is primarily driven by an increase in fat mass and is more likely to occur in individuals with polymorphism of the uncoupling protein-2 gene which can alter the metabolic rate [38,39].…”