First Hospital of Fangshan District, Beijing 102400, China.
Chin Med J (Engl). 2009 Dec 20;122(24):2977-80.
Extra glucose load in peritoneal dialysis is an important cause of newly-occurred diabetic mellitus, which initiates insulin treatment in some of the dialytic patients. The purpose of this study was to discuss the influence of the peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients who are on continuous ambulatory peritoneal dialysis (CAPD).
One hundred and forty-five patients with total KT/V per week over 2.0 were recruited, including 60 males and 85 females. Fasting blood glucose (FBG), creatinine, blood urea nitrogen (BUN), blood albumin, blood lipid profile and blood C-reactive protein (CRP) were analyzed at the beginning of the peritoneal dialysis and after 12 months. A peritoneal equilibration test (PET) was carried out at the 3rd month of CAPD, and meantime residual renal function, peritoneal solute clearance rate, ultrafiltration volume and urine volume were also evaluated.
Twenty-one cases were identified as a low transfer group (L), 32 cases as a low average transfer group (LA), 58 cases as a high average transfer group (HA) and 34 cases as a high transfer group (H). At the end of the 12th month, 83 cases had elevated FBG. Through stepwise multiple regression analysis we found the FBG level in these patients was positively related to glucose load and CRP, and negatively related to glucose absorption in the peritoneum (D/D(0)) and blood albumin (P < 0.05). Kaplan-Meier analysis during a 48-month follow-up found the morbidity of hyperglycemia to be 17/34 cases (50.1%) in the high transfer group, 20/58 cases (34.5%) in the high average transfer group, 11/32 cases (34.3%) in the low average transfer group, and 1/21 cases (5.4%) in the low transfer group.
Patients with high peritoneal transfer capacity might have the highest morbidity from hyperglycemia among patients with these four different peritoneal transfer status. Glucose load, baseline CRP and FBG level before peritoneal dialysis, and D/D0 can efficiently predict hyperglycemia in CAPD patients.
腹腔透析中的额外葡萄糖负荷是新发生糖尿病的重要原因，这会导致一些透析患者开始胰岛素治疗。本研究旨在探讨持续非卧床腹膜透析（CAPD）患者中，不同腹膜转运状态对空腹血糖的影响。
共纳入 145 例每周总 KT/V 超过 2.0 的患者，其中男 60 例，女 85 例。在开始腹膜透析和 12 个月后，分析空腹血糖（FBG）、肌酐、血尿素氮（BUN）、血白蛋白、血脂谱和血 C 反应蛋白（CRP）。在 CAPD 的第 3 个月进行腹膜平衡试验（PET），同时评估残余肾功能、腹膜溶质清除率、超滤量和尿量。
21 例为低转运组（L），32 例为低平均转运组（LA），58 例为高平均转运组（HA），34 例为高转运组（H）。在第 12 个月末，83 例患者 FBG 升高。通过逐步多元回归分析，我们发现这些患者的 FBG 水平与葡萄糖负荷和 CRP 呈正相关，与腹膜内葡萄糖吸收（D/D(0)）和血白蛋白呈负相关（P<0.05）。Kaplan-Meier 分析在 48 个月的随访中发现，高转运组的高血糖发病率为 17/34 例（50.1%），高平均转运组为 20/58 例（34.5%），低平均转运组为 11/32 例（34.3%），低转运组为 1/21 例（5.4%）。
在这四种不同腹膜转运状态的患者中，具有高腹膜转运能力的患者可能出现高血糖的发病率最高。腹膜透析前的葡萄糖负荷、基线 CRP 和 FBG 水平以及 D/D0 可以有效地预测 CAPD 患者的高血糖。
