Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis.

INTRODUCTION: Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♢ OBJECTIVE: We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♢ METHODS: This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♢ RESULTS: We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low- and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♢ CONCLUSIONS: These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.

Effect of diabetes and peritoneal transport characteristic on the cardiac structure and function of patients with continuous ambulatory peritoneal dialysis / 中国综合临床

Objective To compare the cardiac structure and function between diabetic and non-diabetic with different peritoneal transport type.Methods A total of 84 patients with continuous ambulatory peritoneal dialysis (CAPD) in our center for 6 months were enrolled in this study.Forty-six patients of subjects were diabetic,another 38 were non-diabetic.Patients were divided into four groups according to the results of peritoneal equilibration test (PET) and the ratio of creatinine concentration in dialysate solution and plasma (D/P creatinine concentration).Patients with D/P creatinine concentration ＞ 0.65 were with high permeability and otherwise were low permeability.The four groups were diabetic-H (high permeability) group,diabetic-L(low permeability) group,non-diabetic-H (high permeability) group,non-diabetic-L (low permeability) group.The levels of left atrial diameter (LAD),left ventricular diameter(LVD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF) were measured before and after 6-month peritoneal dialysis by ultrasonic doppler.Results Before peritoneal dialysis,there were no significant difference in the terms of all parameters among four groups(P ＞0.05).After 6 months of peritoneal dialysis,the albumin levels,IVST,LVPWT and LVEF in diabetic-L group,non-diabetic-L,diabetic-H group and non-diabetic-H group were ((36.57 ± 3.34),(37.21 ± 4.12),(34.19 ± 3.98),(34.51 ± 4.52) g/L respectively;F =9.034),((10.45 ± 1.12),(10.17 ± 1.35),(11.32 ± 1.09),(11.46 ± 1.38) mm respectively;F =7.525),((9.58 ± 1.42),(9.47 ± 1.31),(10.71 ± 1.40),(10.15 ± 1.41) mm respectively; F =4.963) and ((63.98 ± 4.73) ％,(63.92 ± 5.17) ％,(60.12 ± 5.12) ％,(61.43 ± 5.57) ％respectively ;F =6.984),and the differences were statistic significant (P ＜ 0.05).Compared to diabetic-H group and non-diabetic-H group,there were significant difference in the terms of all above indexes between diabetic-L group,non-diabetic-L (P ＜ O.05).Conclusion The peritoneal transport.type of diabetic patients is high permeability,which might be an important factor affecting cardiac complications in patients.

Relationship between peritoneal transport type and serum C-reactive protein in maintenance peritoneal dialysis patients / 中国医师进修杂志

Objective To evaluate the relationship between peritoneal transport type and serum C-reactive protein (CRP) in maintenance peritoneal dialysis (MPD) patients.Methods Standard peritoneal equilibration test (PET) was performed in 56 MPD patients (MPD group) with regular follow-up.According to D/P values,56 patients were divided into high permeability group (D/P ＞ 0.65,18 cases) and low permeability group (D/P ≤ 0.65,38 cases).In parallel at the date of PET examination,serum creatinine,blood urea nitrogen,uric acid,CRP and dialysate creatinine,blood urea nitrogen,uric acid was tested with an automatic biochemical analyzer,and urea clearance index and creatinine clearance rate was calculated.Dialysis prescription was formulated according to PET results to reach the criteria urea clearance index ≥ 1.7 and creatinine clearance rate ≥ 50 L/(week· 1.73 m2).Six months after MPD treatment,these indexes were detected again.And 20 cases of healthy person (control group) and 30 cases of uremic non-dialysis patients (uremic non-dialysis group) were selected randomly.Results The serum CRP level in high permeability group,low permeability group,uremic non-dialysis group was higher than that in control group [(54.41 ± 17.77),(43.34 ± 18.07),(39.10 ± 17.86) mg/L vs.(2.00 ±0.36) mg/L,P＜ 0.05].The serum CRP level in high permeability group was higher than that in low permeability group (P ＜ 0.05).There was no significant difference in the serum CRP level between MPD group and uremic non-dialysis group (P ＞0.05).There was no significant difference in the serum CRP level between 6 months after MPD and the date of the PET examination in high permeability group,low permeability group (P ＞ 0.05).Six patients with low permeability peritoneal transport changed into the high permeability at 6 months after MPD.The serum CRP level in these 6 patients at 1 month after catheter were significantly higher than the other patients of the low permeability [(64.45 ± 13.05) mg/L vs.(39.38 ± 16.12) mg/L,P ＜ 0.05].Conclusions Uremic patients in vivo exist micro-inflammatory state.The peritoneal transport characteristics of MPD patients are mainly in low permeability.Peritoneal transport characteristics of high permeability in vivo in patients with existing micro-inflammatory status are more severe than those in patients with low permeability.MPD treatment can not change the serum CRP levels in uremic patients.The original micro-inflammatory state in uremic patients may affect their peritoneal transport type.