Abstract
To investigate and compare glucose and lipid metabolism biomarkers in non-diabetic peritoneal dialysis and hemodialysis patients. The study followed a prospective and cross-sectional design. Participants included all prevalent end-stage renal disease patients under renal replacement therapy treated in a university-based clinic. There were no interventions. Blood samples were taken after 8 hours of fasting. Insulin serum levels were determined by chemiluminescence. Insulin resistance were assessed by the insulin sensitivity check index (QUICKI) determined as follow: 1/[log(Io) + log(Go)], where Io is the fasting insulin, and Go is the fasting glucose. HOMA index was also measured: (FPG × FPI)/22.5; FPG = fasting plasma glucose (mmol/L); FPI = fasting plasma insulin (mU/mL). The others biochemical exams were measured utilizing the routine tests. We screened 154 patients (80 on hemodialysis and 74 on peritoneal dialysis). Seventy-four diabetic patients were excluded. Of the remaining 80 patients (55% males, mean age 52 ± 15 years), 35 were on peritoneal dialysis and 45 on hemodialysis. Fasting glucose of peritoneal dialysis patients compared to hemodialysis patients were 5.0 ± 0.14 versus 4,58 ± 0.14 mmol/L, p<0.05; glycated hemoglobin 5.9 ± 0.1 versus 5.5 ± 0.1%, p < 0.05; total cholesterol 5.06 ± 0.19 versus 3.39 ± 0.20 mmol/L, p < 0.01; LDL-c 2.93 ± 0.17 versus 1.60 ± 0.17 mmol/L, p < 0.01; and index HOMA 3.27 versus 1,68, p < 0,05. Importantly, all variables were adjusted for age, gender, dialysis vintage, calcium-phosphorus product, albumin and C-reactive protein levels. We observed a worst profile of lipid and glucose metabolism biomarkers in peritoneal dialysis patients (lower insulin sensitivity and higher fasting glucose, HbA1c, total cholesterol and LDL-c) when compared to hemodialysis, potentially due to the glucose-based dialysis solutions utilized in the peritoneal dialysis population.
Highlights
Carbohydrate metabolism disturbances are known factors potentially associated with cardiovascular complications in patients with chronic kidney disease (CKD)
There was a trend to peritoneal dialysis (PD) patients to have higher abdominal waist circumference (93.3 ± 12.8 versus 87.5 ± 12.1 cm; p = 0.06), which was taken after a complete drainage of dialysis solution from the peritoneal cavity, while body mass index (BMI) was slightly, but with no statistical difference, lower in HD patients (23.6 ± 4.2 versus 25 ± 5.1 kg/m2; p = 0.22)
There was no statistical difference in diastolic blood pressure, the significant higher systolic blood pressure observed in HD patients (148 ± 17 versus 133 ± 30 mmHg; p < 0.01) lead to a higher pulse pressure in these patients (65.5 ± 11.8 versus 51.6 ± 15.1 mmHg; p < 0.01)
Summary
Carbohydrate metabolism disturbances are known factors potentially associated with cardiovascular complications in patients with chronic kidney disease (CKD). Patients with no previous history of glucose intolerance are more likely to develop hyperglycemia and de novo diabetes after the initiation of PD therapy, as described in previous studies[7,8]. Such high glucose load offered during PD therapy can contribute to insulin resistance and worsening of dyslipidemia. The aim of this study was to compare biomarkers of carbohydrate and lipid metabolism in non-diabetic PD and HD patients
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