Peritoneal Dialysate Glucose Load and Systemic Glucose Metabolism in Non-Diabetics: Results from the GLOBAL Fluid Cohort Study

Glucose control is a significant predictor of mortality in diabetic peritoneal dialysis (PD) patients. During PD, the local toxic effects of intra-peritoneal glucose are well recognized, but despite large amounts of glucose being absorbed, the systemic effects of this in non-diabetic patients are no...

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Bibliographic Details
Published in:PloS one 2016-06, Vol.11 (6), p.e0155564
Main Authors: Lambie, Mark, Chess, James, Do, Jun-Young, Noh, Hyunjin, Lee, Hi-Bahl, Kim, Yong-Lim, Summers, Angela, Williams, Paul Ford, Davison, Sara, Dorval, Marc, Topley, Nick, Davies, Simon John
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Biology and Life Sciences
Cohort analysis
Complications and side effects
Diabetes mellitus
Diabetes Mellitus - metabolism
Diabetics
Dialysis
Female
Glucose
Glucose - metabolism
Health aspects
Health risk assessment
Humans
Male
Medicine and Health Sciences
Metabolism
Middle Aged
Mortality
Multivariate analysis
Patients
People and Places
Peritoneal Dialysis
Peritoneum
Physical Sciences
Physiological aspects
Prospective Studies
Sodium
Survival
Toxicity
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Summary:Glucose control is a significant predictor of mortality in diabetic peritoneal dialysis (PD) patients. During PD, the local toxic effects of intra-peritoneal glucose are well recognized, but despite large amounts of glucose being absorbed, the systemic effects of this in non-diabetic patients are not clear. We sought to clarify whether dialysate glucose has an effect upon systemic glucose metabolism. We analysed the Global Fluid Study cohort, a prospective, observational cohort study initiated in 2002. A subset of 10 centres from 3 countries with high data quality were selected (368 incident and 272 prevalent non-diabetic patients), with multilevel, multivariable analysis of the reciprocal of random glucose levels, and a stratified-by-centre Cox survival analysis. The median follow up was 5.6 and 6.4 years respectively in incident and prevalent patients. On multivariate analysis, serum glucose increased with age (β = -0.007, 95%CI -0.010, -0.004) and decreased with higher serum sodium (β = 0.002, 95%CI 0.0005, 0.003) in incident patients and increased with dialysate glucose (β = -0.0002, 95%CI -0.0004, -0.00006) in prevalent patients. Levels suggested undiagnosed diabetes in 5.4% of prevalent patients. Glucose levels predicted death in unadjusted analyses of both incident and prevalent groups but in an adjusted survival analysis they did not (for random glucose 6-10 compared with
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0155564