A Model To Estimate Glucose Absorption in Peritoneal Dialysis: A Pilot Study

Abstract

Background: Glucose absorption in peritoneal dialysis (PD) patients may contribute to adverse metabolic effects. Previous studies on glucose absorption were done on continuous ambulatory PD (CAPD) patients, with long dwell time. However, the growing majority of contemporary PD patients perform automated peritoneal dialysis with short dwell time. Moreover, membrane characteristics and dwell time determine small solute transport across the peritoneal membrane. Methods: In our pilot study, we used data from peritoneal equilibration test (PET) to develop a model to estimate glucose absorption. In six randomly selected PD patients, we calculated actual glucose absorption from directly measuring effluent glucose concentration. We then used R programming language to create non-linear least squared regression model inputting PET data, D2/D0 and D4/D0 to generate exponential decay curve. This model was then utilized to estimate the fraction of glucose remaining in the dialysate at a particular dwell time t (Dt/D0). Daily glucose absorption was calculated by multiplying 1-Dt/D0 with the amount of glucose the patient was exposed to in 24 hours. Results: We observed the mean glucose absorption (89.7 ± 28.8 g/d) as measured from the effluent very close to our estimate (88.12 ± 28.9 g/d) and the difference between the glucose estimation and actual absorption was not statistically significant (p>0.05). After validating our hypothesis, we randomly selected an independent cohort of 11 ESRD patients on various PD modalities and analyzed the data. We observed that mean daily glucose absorption of 62.7 ± 24.5 g (27.98-110.35 g), much lower than that reported in the literature and depends upon dwell times and membrane characteristics in addition of amount of glucose exposure. Conclusions: Our model provides a simple tool to estimate glucose absorption and caloric load in contemporary PD patients. Hopefully, accurate estimation of caloric load and incorporating it in the

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