Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

Am J Nephrol. 2017;46(1):47-54. doi: 10.1159/000477829. Epub 2017 Jun 21.

Abstract

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently.

Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes.

Main results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics.

Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.

Keywords: Diabetes mellitus; Free water transport; Overhydration; Peritoneal dialysis; Small solute transport; Ultrafiltration.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Biological Transport
  • Creatinine / blood
  • Cross-Sectional Studies
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / metabolism*
  • Diabetic Nephropathies / therapy
  • Female
  • Glucose / metabolism
  • Hemodiafiltration / statistics & numerical data*
  • Hemodialysis Solutions / chemistry
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / metabolism*
  • Kidney Failure, Chronic / therapy
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Peritoneal Dialysis / statistics & numerical data*
  • Peritoneum / metabolism*
  • Sodium / blood
  • Sodium / metabolism
  • Water / metabolism*

Substances

  • Hemodialysis Solutions
  • Water
  • Sodium
  • Creatinine
  • Glucose