PurposeDiabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients.MethodsA total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels.ResultsThere were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P<0.05), AlbF (r = 0.54, P<0.01), and HbA1c (r = 0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7–8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged.ConclusionHbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates.
The acetate-base regimen can decrease the occurrence of metabolic acidosis after parenteral nutrition. In addition, the risk of acidosis is higher in patients with impaired renal function.
A gas chromatographic method is described which allows estimation of bretylium, a quarternary ammonium compound, in plasma and urine at drug concentrations as low as 0.07 fig per milliliter. This sensitivity allows the measurement of plasma levels of bretylium in patients receiving therapeutic doses. The plasma level of bretylium in man does not decrease as a first-order function. During the first 24 hours after drug administration the half-life increased from 1 to 5.5 hours. In man, 70 to 80 per cent of an intramuscular dose of bretylium was excreted unchanged in the urine within 24 hours and an additional 10 per cent was excreted during the next 3 days. In the rat, 63 per cent of an intramuscular dose was excreted unchanged in the urine; 31 per cent was excreted unchanged in the feces. Excretion into the bile probably accounts for the bretylium found in rat feces.
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