24-h Glycaemic profiles in peritoneal dialysis patients and non-dialysis controls with advanced kidney disease

Perit Dial Int. 2022 Sep;42(5):497-504. doi: 10.1177/08968608211047787. Epub 2021 Sep 27.

Abstract

Background: For patients on peritoneal dialysis (PD), the deleterious effects of high concentrations of dialysate glucose on the peritoneal membrane are well-documented. Systemic effects of peritoneally absorbed glucose are more poorly defined. Using continuous glucose monitoring (CGM), we aimed to describe 24-h glycaemic profiles of PD patients without diabetes and compare with non-dialysis controls with stage 5 chronic kidney disease (CKD-5).

Methods: In this cross-sectional, case-control study, 15 patients on PD (9 automated PD (APD) and 6 continuous ambulatory PD (CAPD)) and 16 CKD-5 controls underwent 72 h of CGM and metabolic profiling. CGM was used to derive average glucose concentrations and within-participant standard deviation (SD) of glucose. Data were analysed for the whole 72-h monitoring period and as daytime (09.00 to 21.00) and night-time (21.00 to 09.00).

Results: Average glucose concentrations and within-participant SD of glucose for the whole monitoring period were not different between the three groups (p ≥ 0.5). Daytime average glucose concentrations were also similar across the three groups (p = 0.729). APD was associated with a significantly higher nocturnal glucose than CAPD (5.25 mmol/L ± 0.65 vs. 4.28 ± 0.5, p = 0.026). A significant drop in nocturnal glucose compared with daytime average seen in both CAPD patients and controls was absent in APD patients.

Conclusions: Systematically different glycaemic patterns were observed in non-diabetic APD and CAPD patients, including an absence of physiological nocturnal glucose dipping in patients on APD. Comprehensive CGM data sets highlight subtleties not appreciated by traditional metabolic biomarkers; this has implications when choosing the most appropriate outcome measures in future research addressing the metabolic impact of PD.

Keywords: Continuous glucose monitoring; metabolic; peritoneal dialysis.

MeSH terms

  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Case-Control Studies
  • Cross-Sectional Studies
  • Glucose
  • Humans
  • Kidney Diseases*
  • Kidney Failure, Chronic* / metabolism
  • Peritoneal Dialysis* / adverse effects

Substances

  • Blood Glucose
  • Glucose