Strategies to Reduce Glucose Exposure in Peritoneal Dialysis Patients

Abstract

Glucose has been used successfully for more than two decades in peritoneal dialysis, and in this regard, must be considered a safe and effective osmotic agent. Recently, however, insight has been growing about the potential for metabolic and peritoneal effects arising from long-term exposure to high glucose concentrations—for example, hyperlipidemia and loss of peritoneal ultrafiltration. Clinical concerns over exposure to excessive glucose and glucose degradation products (GDPs) during peritoneal dialysis can be significantly ameliorated by the use of non-glucose-based peritoneal dialysis (PD) solutions, in combination with more biocompatible glucose-based formulations. Peritoneal exposure to GDPs can be reduced by using low-GDP-containing glucose formulations and non glucose solutions such as amino acids and icodextrin. Peritoneal glucose exposure, hyperosmolar stress, and carbohydrate absorption can be reduced by using a combination of icodextrin and amino acids.

Glucose sparing in peritoneal dialysis: Implications and metrics

“…A simple model described in 2000 calculated an absorption of 120 g of carbohydrate per day in a CAPD average transporter using three 5-h exchanges of 1.5% dextrose and one 9-h long dwell of 4.25% dextrose. 3 By substituting the long dwell with icodextrin, this carbohydrate absorption was reduced by 27%. If one of the 1.5% dextrose exchanges was also replaced with an amino-acid solution, the total reduction in carbohydrate uptake was 42%.…”

Management of hyperlipidemia in patients on peritoneal dialysis: Current approaches

“…With regard to the PD solutions, a prescription that includes 7.5% icodextrin and 1.1% amino acids (Nutrineal, Baxter Healthcare Corporation, McGaw Park, IL, USA) which are glucose free, offers 40% less carbohydrate absorption than a regime that is glucose based with three exchanges of 1.5% dextrose and one exchange of 4.25% dextrose. 30 Three studies have evaluated the impact of replacing a glucose-based exchange with an amino-acid-or icodextrin-based solution. A randomized, crossover study in 22 PD patients replaced a glucose exchange with icodextrin or 1.1% amino acids.…”

Recommendations for the use of icodextrin in peritoneal dialysis patients

“…The routine use of conventional glucose-based solutions in PD has been linked to a number of adverse metabolic consequences of systemic glucose absorption, including hyperglycaemia, hyperinsulinaemia, hyperlipidaemia, obesity, suppressed appetite and altered food preference. [9][10][11]25 As icodextrin is a solution containing a spectrum of high molecular weight polysaccharides (average molecular weight 16 200 Da) that are slowly absorbed across the peritoneal membrane, it has been suggested that certain patient groups such as diabetics may benefit from the use of such a non-glucose solution. In the MIDAS study, 13 total carbohydrate absorption during an 8-h dwell was measured in seven controls (six on 3.86% and one on 2.27%), and 11 icodextrin-treated patients.…”