Does peritoneal dialysis really intensify the carbohydrate exchange disorders in nondiabetic patients?
| Main Authors: | Natalia Stepanova, Olena Burdeyna, Victoria Driianska, Lyudmila Snisar |
|---|---|
| Format: | Proceeding eJournal |
| Bahasa: | eng |
| Terbitan: |
, 2018
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| Subjects: | |
| Online Access: |
https://zenodo.org/record/3344798 |
Daftar Isi:
- INTRODUCTION AND AIMS: Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand glucose absorption from the peritoneal cavity may lead to the development of insulin resistance (IR). The aim of our study was to investigate the impact of PD initiation on the carbohydrate exchange disorders in non-diabetic end-stage renal disease (ESRD) patients. METHODS: A total of 15 patients with ESRD, who started treatment with continuous ambulatory peritoneal dialysis (CAPD) have been included in this longitudinal, observational cohort study. All patients were male, (the average age 49.6 ± 5.9). Treatment with CAPD was performed using Dianeal PD 4 with a glucose concentration of 1.36% and 2.27% (Baxter Healthcare Corporation, USA). Patients were screened before initiation of PD, in 3 and 12 months of treatment. All patients were determined for the insulin, leptin and C-peptide blood levels using ELISA-method. The concentration of insulin was analyzed using antibodies against the human insulin molecule using the DRG Instruments GmbH (Germany) reagents. The Flexor junior biochemical analyser (The Netherlands) was used to study glucose. The insulin resistance index (HOMA-IR) (Homeostatic Model Assessment), which is characterized by the degree of insulin resistance, was calculated by the formula: level of insulin onset (μSO / ml) × blood glucose onset (mmol / l) / 22.5. The IR was diagnosed with a HOMA index value of ≥ 2.77 unit. For the statistical analysis we used MedCalc. The normal distribution of data was verified using the Shapiro-Wilks criterion. The average values (M) and standard deviation (SD) or the median (Me) and interquartile ranges [Q25-Q75] were calculated according to a normal distribution. The Mann-Whitney (U) and Student’s t-criterion were used to compare them. RESULTS: Among all ESRD patients examined before PD initiation significant increase of carbohydrate exchange rates investigated was shown. After 3 months of PD treatment inspected patients’ blood insulin had decreased whereas leptin and C-peptide levels hadn’t changed significantly. HOMA-IR after PD initiation had dropped by 63 % (tabl. 1). CONCLUSIONS: PD treatment during 12 months significantly reduces insulin resistance level in CKD stage V paients. Further research are needed to identify the influence of long-term treatment with glucose-containing solutions onto IR state among PD patients.