The effect of glucose absorption from peritoneal dialysates on changes in lipid profiles in prevalent peritoneal dialysis patients.

Abstract

The majority of peritoneal dialysates contain glucose, which can potentially be absorbed from the peritoneal cavity. Previous studies have reported an observation between dialysate glucose exposure and increases in total cholesterol (TC), low-density lipoproteins (LDLs) and triglycerides (TGs). As most of these studies reported glucose exposure in peritoneal dialysis (PD) patients treated by continuous ambulatory peritoneal dialysis (CAPD), we wished to determine whether measured peritoneal glucose absorption resulted in an increase in lipid profile with CAPD and automated PD (APD) cycler treatments. Glucose absorption was measured in 143 patients; 89 (62.2%) males, 53 (37.1%) diabetics, mean age 61.3 ± 14.9 years, with 90 (62.1%) using a daytime icodextrin exchange; 37 (25.9%) CAPD, attending for their first assessment of peritoneal membrane function, when PD prescriptions were then individualised for peritoneal transporter status and repeated after 12 months. Median glucose absorption was 172.5 (75.5-265.5) mmol/day. Although glycated haemoglobin increased (42 ± 16 to 45.4 ± 17.7 mmol/mol, p = 0.006), there was no change in TC (4.8 ± 1.3 to 4.7 ± 1.3 mmol/L), high-density lipoproteins (1.39 ± 0.45 to 1.33 ± 0.51 mmol/L), LDL (2.48 ± 1.12 to 2.21 ± 0.87 mmol/L) or TGs (2.0 (1.3-2.6) to 2.0 (1.3-2.8) mmol/L, adjusted p > 0.05). We found no association between glucose absorption and either lipid profiles or changes in serum lipids. In the current era of APD cyclers and icodextrin, PD prescriptions can be individualised to accommodate patients with a different peritoneal transport status, so that despite daily glucose absorption from dialysates, and a minor increase in glycated haemoglobin, we were unable to demonstrate any significant increase in standard lipid profiles.