Effect of energy metabolism on the onset and maintenance of metabolic syndrome in peritoneal dialysis patients / 中华肾脏病杂志

ABSTRACT

Objective To clarify the association of onset and maintenance of metabolic syndrome (MS) with energy metabolism imbalance,especially with dialysate glucose load in peritoneal dialysis (PD) patients.Methods Using retrospective self-controlled study,the changes of MS,dialysate glucose load and dietary energy intake (DEI) in 126 PD patients in about 1 year were collected and analyzed to define the effect of energy intake on MS.Resting energy expenditure (REE) was measured and physical activity level (PAL) was evaluated based on the activity records in PD patients with unchanged MS state and their impacts on MS were analyzed.Results The incidence of changing from non-MS to MS was higher in glucose load increasing group than that of glucose load unchanged or decreasing group.When glucose load increased,patients developing MS had significantly increased serum triglyceride (TG) level (P＜0.01) and significantly decreased serum high density lipoprotein cholesterol (HDL-C) level (P＜0.05),while the waist circumference and blood glucose level did not alter significantly.In patients changing from MS to non-MS,their serum C reactive protein (CRP) levels significantly decreased during the follow-up (P＜0.05).No significant difference was found in DEI in patients changing from MS to non-MS.However,in patients changing from non-MS to MS,their DEI decreased during the follow up (P＜0.05).In a subgroup analysis in 36 PD patients who maintained their metabolic status and did not change their glucose load,there was no difference in REE per body surface per day between the MS group and the nonMS group (t=0.840,P＞0.05).However,the PAL was lower in the MS group than that of the nonMS group (t=2.358,P＜0.05).Conclusions The increase of dialysate glucose load may be an important factor leading to the onset of MS,by altering serum TG and HDL-C level.Inflammation and the sedentary life also contribute to the MS state.