The impact of the peritoneal glucose load index on hydration status and inflammation in peritoneal dialysis patients

Abstract

Objective: To evaluate the impact of the peritoneal glucose load (PGL) on hydration status and inflammation in peritoneal dialysis (PD) patients. Methods: This cross-sectional study evaluated stable PD patients using a novel PGL index (PGLI), which was calculated as the net glucose content (g) in the PD solutions administered in the daily PD prescription divided by the dry body weight (kg) assessed by whole-body bioimpedance spectroscopy. The relationship between PGLI and glycosylated haemoglobin (HbA 1c ), fluid overload (FO), and inflammatory markers was investigated. Results: A total of 43 stable PD patients participated in the study. Significant positive correlations were found between PGLI and HbA 1c , FO, plasma high sensitivity C-reactive protein (hsCRP), and plasma interleukin-6 (IL-6) levels. HbA 1c , FO, plasma hsCRP and plasma IL-6 levels were significantly higher in patients with PGLI >3 g/kg/day compared with those with PGLI 3 g/kg/day. Conclusions: PGLI values >3 g/kg/day may be associated with poor glycaemic control, over hydration and augmented inflammation. PGLI might be a useful tool for the quantitative assessment of the PGL and could be applied when managing PD patients.

Clinical parameters before and after the transition to dialysis

“…Although a relatively crude index of inflammation, WBC counts have been found to be related to outcome in dialysis patients. 18 Regarding the difference between survivors and nonsurvivors, WBC counts are generally higher in the nonsurvivor group, both in the pre-dialysis and in the vintage phase, but slopes of change in the pre-dialysis period are not significant. There are several possible explanations for the increase in WBC count in the late pre-dialysis phase, such as the placement of central venous catheters 16 or the proinflammatory effect of fluid overload 17 or uremic toxins.…”

“…There are several possible explanations for the increase in WBC count in the late pre-dialysis phase, such as the placement of central venous catheters 16 or the proinflammatory effect of fluid overload 17 or uremic toxins. 18 Regarding the difference between survivors and nonsurvivors, WBC counts are generally higher in the nonsurvivor group, both in the pre-dialysis and in the vintage phase, but slopes of change in the pre-dialysis period are not significant.…”

Risk of serous retinal detachment in patients with end-stage renal disease on dialysis

“…First, chronic inflammation is more common in patients with ESRD on PD than patients on HD and considered a common pathogenic mechanism for serous retinal detachment [13]. The chronic inflammation in PD patients is related to the peritoneal glucose load which leads to fluid accumulation due to cumulated peritoneal membrane damage and increased peritoneal membrane permeability [29,30]. Second, vascular injuries such as increased endothelium permeability and atherosclerotic change are more common in patients with ESRD on PD and possible predictors of the development of serous detachment [31].…”

Associations of Peritoneal Glucose Load With Male Sexual Dysfunction and Depression in Peritoneal Dialysis Patients

“…After undergoing complete medical history and physical examination, all participants were assessed for peritoneal glucose load index (PGLI), hydration status, sexual function, psychological status and sex hormonal profile. The PGLI refers to the net glucose content (monohydrated or unhydrated) (g) in the solutions administered in the daily PD prescription, divided by the dry body weight (kg), as assessed by whole‐body bioimpedance spectroscopy : …”

“…For analysis, patients were categorized to two groups according to PGLI ≤3 g/kg per day and PGLI >3 g/kg per day. The cut‐off of 3 g/kg per day is based in our previous studies that evaluated the impact of PGLI on hydration status, inflammation and left ventricular mass in stable patients on maintenance PD . These studies demonstrated that hemoglobin A1c (HbA1c), fluid overload, plasma high sensitivity C‐reactive protein (hsCRP) and interleukin (IL)‐6 levels were significantly higher in patients with PGLI >3 g/kg per day compared with those with PGLI ≤3 g/kg per day ; PGLI was positively correlated with HbA1c and left ventricular mass index ( P < 0.001) and patients with PGLI >3 g/kg per day had higher HbA1c and left ventricular mass index compared to those with PGLI ≤3 g/kg per day ( P < 0.001) ; PGLI seemed to be possible predictor of left ventricular hypertrophy and its cutoff that was associated with the presence of LVH was 3.2 g/kg per day ; and finally, low peritoneal glucose load was associated with a protective effect from the development of left ventricular hypertrophy in PD patients .…”