Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis

Abstract

Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.

Plasma myeloperoxidase, NT‐proBNP, and troponin‐I in patients on CAPD compared with those on regular hemodialysis

“…2 On the other hand, different authors illustrated the prognostic importance of measuring carotid intima-media thickness (CIT) in patients with ESRD. [10][11][12] All these factors together play an important role in the pathogenesis of hypertension and atherosclerosis. 13 Particularly, in continuous ambulatory peritoneal dialysis (CAPD) patients, exposure to glucose in dialysis solutions may accentuate these metabolic abnormalities.…”

“…13 Particularly, in continuous ambulatory peritoneal dialysis (CAPD) patients, exposure to glucose in dialysis solutions may accentuate these metabolic abnormalities. 12 The negative effects of these factors may be clinically assessed by measuring the degree of CIT. 14 On the other hand, the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in identification and prognostication of patients with possible ventricular dysfunction is already established.…”

Establishing HbA1c–mean blood glucose formulae for patients on continuous ambulatory peritoneal dialysis

“…Meanwhile, serum albumin has also been included in HbA 1c -mean blood glucose formulae for haemodialysis [9]. Serum creatinine possibly acts as an independent variable because of changes in various clinical factors such as glucose metabolism and metabolic acidosis, along with the severity of end-stage renal disease, which might influence the formation of HbA 1c [18]. Interestingly, the formation of HbA 1c was significantly influenced by haemoglobin concentration in people on dialysis [3] and, in HbA 1c -mean blood glucose formulae for people on haemodialysis [9], haemoglobin was included in the models as a confounding variable.…”

Glycemic Control in Diabetic Patients on Long-Term Maintenance Dialysis

“…Insulin affects cells through binding to its receptor on the surface of insulin-responsive cells. The stimulated insulin receptor phosphorylates itself, and several substrates including membranes of the insulin receptor substrate family and initiate downstream signaling events [27].…”

“…However, predictors for exogenous insulin requirement in patients with type 2 diabetes undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been defined. Possible factors include β-cell function, endogenous metabolism and elimination of insulin, insulin resistance, body size, carbohydrate intake, and extra glucose absorbed from dialysate fluid [27].…”