The Benefit of a Glucose-Sparing PD Therapy on Glycemic Control Measured by Serum Fructosamine in Diabetic Patients in a Randomized, Controlled Trial (IMPENDIA)

Abstract

Background/Aims: Poor glycemic control can lead to increased morbidity and mortality in peritoneal dialysis (PD) patients. Serum fructosamine may be a more reliable marker of glycemic control than HbA1c in dialysis patients. Methods: We evaluated the effects of a glucose-sparing PD regimen on serum fructosamine. In the multicenter, controlled IMPENDIA trial, eligible diabetic PD patients were randomized (1:1) to a 24-hour combination of a glucose sparing regimen (n = 89) or a glucose-based therapy (n = 91). Serum fructosamine and HbA1c were measured at baseline, 3 months and 6 months; fructosamine measurements were corrected for serum albumin (AlbF). Results: Serum fructosamine decreased from 297 to 253 µmol/l in the glucose-sparing group (95% confidence interval [CI] for the difference, −26 to −68, p < 0.001), and increased from 311 to 314 µmol/l in the glucose-only group (95% CI for the difference, −23 to +19, p = 0.87). The mean difference in change of fructosamine levels between groups at 6 months was 64 µmol/l (95% CI 29-99, p < 0.001). HbA1c decreased versus baseline in both groups (treatment difference 0.3%, p = 0.07). The correlation between AlbF and baseline fasting serum glucose was stronger than that seen between HbA1c and baseline fasting serum glucose (r = 0.47, p < 0.0001 and r = 0.31, p < 0.0001, respectively). Conclusion: A glucose-sparing regimen (P-E-N) improved glycemic control as measured by serum fructosamine. Further studies are needed to establish fructosamine targets that will reduce the morbidity risk related to hyperglycemia in PD patients.

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

“…86,127 However, our analysis showed no difference in HbA 1c and fasting plasma glucose levels between groups. Given results of the IMPENDIA-EDEN trial, 128,129 a single exchange of icodextrin per day instead of glucose may be clinically insufficient as a glucose-sparing PD regimen. Alternatively, the effect may be too small to be demonstrable in our data set, which includes many nondiabetic patients (a "sub-metaanalysis" of the effect of icodextrin-containing PD regimens on glycemic control exclusively in diabetic patients is underway).…”

Associations between Peritoneal Glucose Exposure, Glucose Degradation Product Exposure, and Peritoneal Membrane Transport Characteristics in Peritoneal Dialysis Patients: Secondary Analysis of thebalANZ Trial

“…G lucose is the most common osmotic medium used in peritoneal dialysis (PD) solutions and is used in varying concentrations (75.5 to 214 mmol/L) to induce ultrafiltration (1,2). Glucose in PD solutions is absorbed and contributes to a number of potential systemic adverse effects, including poor glycemic control, weight gain, dyslipidemia, and increased cardiovascular risk (3 4 5 6 7 8 9-10). Furthermore, the glucose in PD solutions causes damaging local membrane effects, such as membrane thickening and vasculopathy, and immunological effects, such as stimulated inflammatory cytokine secretion and impaired phagocytosis (11,12), perhaps through the effects of advanced glycosylated end-product (AGE) formation and direct cytotoxicity of glucose degradation products (GDPs) on the peritoneum (3,13–20).…”

Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

“…Results and conclusions from the combined (IMPENDIA/EDEN) trials (The Improved Metabolic Control of Physioneal, Extraneal, Nutrineal (P-E-N) versus Dianeal Only in DIAbetic continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) Patients (IMPENDIA), and The Evaluation of Dianeal, Extraneal, Nutrineal (D-E-N) versus Dianeal only in Diabetic CAPD Patients (EDEN)) showed that a low-glucose PD regime improves metabolic indexes in diabetic patients receiving peritoneal dialysis, but may be associated with an increased risk of extracellular fluid volume expansion. Thus, the use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status [ 7 , 9 ].…”

“…Therefore, there has been a considerable interest in minimizing the use of dextrose exposure during PD. The peritoneal dialysis solutions used in combination have reduced the complications and allows a long-time function of the peritoneal membrane, as they also can contribute to reducing the cardiovascular risk of PD patients [ 7 , 8 , 9 ]. On the other-hand, preservation of residual renal function (RRF) in patients on PD is crucial for the maintenance of life quality and long-term survival [ 10 , 11 , 12 , 13 , 14 ].…”