Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

Abstract

Background: Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. Methods: We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. Results: Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion: Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.

Peritoneal Protein Losses Depend on More Than Just Peritoneal Dialysis Modality and Peritoneal Membrane Transporter Status

“…Increased ECW and NT‐proBNP are increased in cases of volume overload in peritoneal dialysis patients , but ECW/TBW and NT‐proBNP can also be increased in inflammatory states , which also can increase capillary protein leakage . In keeping with previous reports, we noted that faster peritoneal transport and diabetes were associated with greater ECW/TBW ratios and NT‐proBNP . As increased NT‐proBNP and ECW/TBW are associated with an increased risk for mortality .…”

Estimated dietary sodium intake in peritoneal dialysis patients using food frequency questionnaires and total urinary and peritoneal sodium losses and assessment of extracellular volumes

“…Previous studies have reported that diabetic patients are more likely to have higher inter-dialytic weight gains and ECW expansion [31,32]. However, we found no differences between our diabetic and non-diabetic patients.…”

Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

“…Interestingly, fluid overload and impaired RRF are closely linked. Udo et al [30] reported that diabetic patients electively starting PD showed greater extracellular water retention 6-10 weeks after starting PD than did non-diabetic patients, despite similar peritoneal function, as determined by the peritoneal equilibration test. In addition, Kim et al [31] reported that an increase in body weight during the first year and diabetes were associated independently with a Fig.…”