Does low peritoneal glucose load protect from the development of left ventricular hypertrophy in peritoneal dialysis patients?

Abstract

Left ventricular hypertrophy (LVH) is a major predictor of the development of cardiovascular events that is considered the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. This study aimed to evaluate retrospectively the impact of low peritoneal glucose load on left ventricular mass (LVM) in PD patients. 36 patients who were on continuous ambulatory PD for at least a period of 2years enrolled in the study. Of them, 23 patients received only glucose-based solutions (GBS) [high peritoneal glucose load group (HPGL group)] from the start of PD, and 13 patients received AAS in combination with GBS when their serum albumin decreased to levels <3.5g/dl [low peritoneal glucose load group (LPGL group)]. AAS was substituted with 1.36% GBS when serum albumin rose to ≥3.5g/dl and restarted when serum albumin fell to <3.5g/dl. Medical history, physical findings, echocardiographic, laboratory and hydration status data from the first month of PD and after 24months, were obtained from each patient's medical records. Mean LVM index (LVMI) increased in both groups (p≤0.010). The increment in mean LVMI was higher in HPGL group compared to LPGL group (p=0.006). At 24months: peritoneal glucose load index (PGLI), fluid overload, mean arterial pressure (MAP), HbA1c and hsCRP were higher in HPGL group (p≤0.010), while 24h ultrafiltration, weekly Kt/V, serum albumin levels and RRF were higher in LPGL group (p≤0.025). The increment (Δ between the values of each parameter from the start of PD and after 24months) in PGLI, fluid overload, MAP, HbA1c and hsCRP values were higher in HPGL group (p<0.001). Low peritoneal glucose load may be associated with a protective effect from the development of LVH in PD patients.