Why are Diabetic Patients Requiring Hypertonic Glucose Dialysate to Achieve Comparable Ultrafiltration Volume During CAPD? / 대한신장학회잡지

PURPOSE: Hyperglycemia, hypoalbuminemia and other factors make diabetic CRF patient vulnerable to salt and fluid retention, which is partial explanation of high mortality rate of DM dialysis patients. This prospective study was carried out to investigate the different membrane characteristics associated with ultrafiltration between diabetic and non diabetic CAPD patients. METHODS: Among new CAPD patients from May 2001 to January 2004 in our hospitals, 60 patients who had complete data more than 12 month were enrolled. Peritoneal equilibration test and D/P1hr Na using 4.25% dialysate, daily ultrafiltration and urine volume, serum albumin and glucose level, daily exposed and daily absorbed glucose amount through the peritoneal cavity and clinical indices were measured at 1st, 6th, and 12th months after initiation of CAPD. We analyzed data with independent t test, repeated measure of ANOVA and multiple regression by STATA. RESULTS: We can summarized the RESULTS: Changes of body weight, total body water, daily ultrafiltration volume (UFV), D/P4Cr, UFV during PET and RRF were not significantly different between DM and non-DM at 1st, 6th, and 12th months. But 1st month serum albumin was lower in DM (p=0.01). Daily exposed glucose amount was significantly higher in DM group at 1st and 12th months (161.7+/-44.5 g/day vs. 140.3+/-21.1 g/day and 157.4+/-43.8 g/ day vs. 134.0+/-11.3 g/day, p=0.019, p=0.006, respectively). At 1st month, D/P1hr Na was not significantly different between DM and non-DM but DM group showed getting higher (D/P)1hr Na at 6th and 12th month (p=0.04, p=0.006, respectively). Factors associated with D/P1hr Na were DM (beta-coeff= -0.015, p=0.042), log hs CRP (beta-coeff=0.012, p= 0.025), 24 hours dialysate albumin (beta-coeff=-0.010, p=0.000), and D/P4Cr (beta-coeff=0.150, p=0.000). CONCLUSION: Diabetic CAPD patients showed more rapid increase of D/P1hr Na during initial 1 year. It might be due to more rapid deterioration of water channel function with time on PD. In terms of achieving adequate ultrafiltration in diabetic peritoneal dialysis patient with time, higher concentration of glucose or icodextrin containing dialysate might be needed to overcome decreased water channel function.

Analysis of the Timing of PET and Factors Influencing PET Results / 대한신장학회잡지

The peritoneal equilibration test(PET) is used as a tool for determining the characteristics of the peritoneal membrane. Initial PET is recommended at least 1 month after peritoneal dialysis, but PET after 1 month may be difficult to perform on an out- patients basis. Two standard PETs(D/P4Cr) were per- formed in 60 CAPD patients(DM:non DM=22:38). Initial PETs, within one week after starting CAPD and follow up PETs, at least 3 months after CAPD were performed. The initial PET values were compared with subsequent PET values. Clinical data (age, sex, body surface area, BMI, presence of diabetes mellitus, ascites) and laboratory indices(serum albumin, dialysate creatinine clearance, KT/V, protein catabolic rate) were compared with the results of the PETs. In initial PET result, there was negative correlation between D/P4Cr and serum albumin(r=-0.522, p<0.001 N=60). There was no significant difference between initial and follow up(mean+/-S.D.:8.84+/-5.2months after CAPD) D/P4Cr(0.68+/-0.14 vs 0.68+/-0.13). But with passage of time, delta D/P4Cr and delta serum albumin were also negatively correlated (r=-0.459, p<0.001). According to the linear regression analysis, the factor significantly associated with D/P4Cr was serum albumin(coefficients -0.111). In conclusion, serum albumin level is the most important predictor of the peritoneal membrane transport characteristics, and it seems that the timing of PET does not matter, rather the changes of with time are strongly correlated with the changes of the serum albumin level.