Carbohydrate and Lipid Metabolism during Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of a Single Dialysis Cycle

Heaton, A.; Johnston, Desmond G.; Burrin, Jacky M.; Ørskov, Hans; Ward, M. K.; Alberti, K. G. M. M.; Kerr, David

doi:10.1042/cs0650539

Cited by 38 publications

(14 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We standardized these procedures not only in a fasting state, but also after the overnight dwell with 1.36% glucose solution, before the PET. Such a protocol minimizes any potential effect of peritoneal glucose absorption, while allowing for dialysis maintenance, as a previous study by Heaton et al showed that there are no differences in fasting plasma glucose and insulin between undialyzed PD patients (with no PD solution in the abdomen) and patients on 1.36% glucose solution, after the first 60 minutes of a 1.36% glucose dwell (38). Assuming this, other investigators focused on metabolic issues, performing measurements after the 1.36% glucose solution overnight dwell (39,40).…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption.Design, setting, participants, & measurements Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4615.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters.Results Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel. FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P,0.001, and 39.4610.1% versus 27.2611.5%, P=0.002, respectively), lower IGFBP-1 (8.267.2 versus 21.0616.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P,0.001).Conclusions Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

show abstract

Section: Discussionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…There is continuous absorp tion of dextrose from dialysis fluid, rapid at the start of the exchange but slower as the fluid concentration falls [6] so that after 6 h about 80% has been absorbed. This may contribute to an elevation of blood sugar, stimula tion of insulin secretion [14] and maintenance of high glycogen stores. Consequently, it is generally assumed that this carbohydrate may be useful in providing calories during periods of illness and malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Nutrition and Delayed Hypersensitivity during Continuous Ambulatory Peritoneal Dialysis in Relation to Peritonitis

Young¹,

Young²,

Young³

et al. 1986

Nephron

View full text Add to dashboard Cite

Anthropometric measurements, sixteen specific plasma proteins, triglycerides, cholesterol, urea and creatinine were measured at 4-monthly intervals for 1 year in 15 patients on CAPD. Delayed hypersensitivity skin tests were performed on 11 patients at the start and after 4 and 12 months. Body weight increased due mainly to a mean increase in ‘calculated’ body fat of 2.0 kg with increases in cholesterol, triglycerides and apolipoprotein B. Gain in fat correlated with the daily supply of dextrose in the dialysis fluid. Albumin, transferrin, prealbumin and retinol-binding protein decreased in 8 patients who intermittently ate less than 1.3 g protein/kg/day. A high concentration of dextrose in the dialysis fluid probably caused loss of appetite. Peritonitis resulted in increases in acute phase proteins although other plasma proteins decreased. Skin test responses indicated improvement in cell-mediated immunity during continuous ambulatory peritoneal dialysis (CAPD). The incidence of peritonitis and length of stay in hospital were greater in the patients who were hypoalbuminaemic probably due to impairment of the humoral mechanism. Dextrose in dialysis fluid may contribute to hyperlipidaemia and malnutrition with impairment of immunocompetence.

show abstract

“…CAPD patients showed the highest degree of glucose intolerance as compared to the nondialyzed uremic and the chronic-hemodialysis subjects. This finding could be related to the considerable daily glucose load to which CAPD patients are perma nently exposed [28]. It seems unlikely that residual glu cose from the last peritoneal exchange may have contrib uted to the higher glucose intolerance present in the CAPD group.…”

Section: Discussionmentioning

confidence: 74%

Insulin Binding and Glycolytic Activity in Erythrocytes from Dialyzed and Nondialyzed Uremic Patients

Weisinger¹,

Contreras²,

Cajias³

et al. 1988

Nephron

View full text Add to dashboard Cite

Insulin resistance in uremia has been attributed to impaired hormone-receptor binding or to postbinding defects. Oral glucose tolerance tests, insulin binding, and in vitro glycolytic activity were studied in purified red blood cells from normal control subjects (C) and from uremic patients belonging to three groups: nondialyzed (U), on chronic hemodialysis (HD), and on continuous ambulatory peritoneal dialysis (CAPD). Glucose intolerance and hyperinsulinemia were demonstrated in all groups of patients. Maximal specific binding of ¹²⁵I-insulin to erythrocytes, kinetically derived receptor numbers per cell, and affinity constants for insulin binding did not differ between control and patient groups. No correlation was found between the degree of glucose intolerance and insulin binding parameters. Basal lactate production by erythrocytes incubated invitro was significantly higher in U and HD patients than in Cwhereas CAPD patients did not differ from C in this respect. Addition of 1 mI dibutiryl-cAMP and 0.5 mM isobutyl-methyl-xanthine during incubation of erythrocytes caused an increase in the rate of lactate production that was similar in magnitude in the U, HD and C groups, whereas cells from CAPD subjects showed a significantly larger absolute response to these compounds after 1 h of incubation. There was no evidence of impairment of glycolytic capacity in red blood cells from uremic patients. In addition, no correlation was found between the degree of glucose intolerance and basal or stimulated lactate production by erythrocytes. Our results obtained in human erythrocytes suggest that the insulin resistance observed in uremia does not involve a defect in hormone binding or in the intracellular capacity to utilize glucose through glycolysis.

show abstract

Carbohydrate and Lipid Metabolism during Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of a Single Dialysis Cycle

Cited by 38 publications

References 31 publications

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Nutrition and Delayed Hypersensitivity during Continuous Ambulatory Peritoneal Dialysis in Relation to Peritonitis

Insulin Binding and Glycolytic Activity in Erythrocytes from Dialyzed and Nondialyzed Uremic Patients

Contact Info

Product

Resources

About