Peritoneal dialysis assists residual renal function to maintain glucose tolerance: A prospective observational study

Background: Renal failure can cause the deterioration of glucose metabolism and increase blood glucose fluctuations, which have been reported to be a factor in the progression of vascular disorders. Little information is available on the daily variation in blood glucose levels in patients with end-stage renal disease (ESRD) and peritoneal dialysis (PD). Methods: Daily plasma glucose excursion was evaluated by continuous glucose monitoring (CGM) for 24-72 h. Fourteen ESRD patients without type 2 diabetic nephropathy (non-diabetic patients) and six ESRD patients with type 2 diabetic nephropathy (diabetic patients) participated in this study. ESRD patients started PD which were undergone in only the daytime, and not in the night time. As the PD solution, Dianeal^®1.5 % PD-2N (1.5 L) was infused intraperitoneally for 3 h three times daily. The patients received standard meals with a total calorie intake of 30 kcal/kg/day and a protein intake of 0.8 g/kg/day before and after initiation of PD. Daily glucose profiles were measured both 2 week before and 1 week after the commencement of PD with CGM system (CGMS). Results: CGMS parameters were compared between before and after the initiation of PD. In non-diabetic patients with ESRD, the maximum glucose concentration (GC) and area under the curve (AUC) of GC >140 mg/dL significantly decreased after PD initiation. In diabetic patients with ESRD, the mean GC, SD, minimum value, AUC of GC >140 mg/dL, and maximum nocturnal GC significantly decreased, while the percentage of nocturnal GC <70 mg/dL markedly increased after PD commencement. In all patients, there was a significant negative correlation between the incidence of hypoglycemia and residual renal function before the initiation of PD and the correlation disappeared after PD initiation. In all patients, the GC range and coefficient of variation were negatively associated with the peritoneal Kt/V value. Conclusions: Residual renal function promotes the maintenance of glucose tolerance in patients with ESRD. Glucose fluctuation improved shortly after initiation of PD, whereas nocturnal hypoglycemia was evident in diabetic patients.