Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter College of Medicine and Health, UK.
Wales Kidney Research Unit, Cardiff University, UK.
Perit Dial Int. 2022 Sep;42(5):497-504. doi: 10.1177/08968608211047787. Epub 2021 Sep 27.
For patients on peritoneal dialysis (PD), the deleterious effects of high concentrations of dialysate glucose on the peritoneal membrane are well-documented. Systemic effects of peritoneally absorbed glucose are more poorly defined. Using continuous glucose monitoring (CGM), we aimed to describe 24-h glycaemic profiles of PD patients without diabetes and compare with non-dialysis controls with stage 5 chronic kidney disease (CKD-5).
In this cross-sectional, case-control study, 15 patients on PD (9 automated PD (APD) and 6 continuous ambulatory PD (CAPD)) and 16 CKD-5 controls underwent 72 h of CGM and metabolic profiling. CGM was used to derive average glucose concentrations and within-participant standard deviation (SD) of glucose. Data were analysed for the whole 72-h monitoring period and as daytime (09.00 to 21.00) and night-time (21.00 to 09.00).
Average glucose concentrations and within-participant SD of glucose for the whole monitoring period were not different between the three groups ( ≥ 0.5). Daytime average glucose concentrations were also similar across the three groups ( = 0.729). APD was associated with a significantly higher nocturnal glucose than CAPD (5.25 mmol/L ± 0.65 vs. 4.28 ± 0.5, = 0.026). A significant drop in nocturnal glucose compared with daytime average seen in both CAPD patients and controls was absent in APD patients.
Systematically different glycaemic patterns were observed in non-diabetic APD and CAPD patients, including an absence of physiological nocturnal glucose dipping in patients on APD. Comprehensive CGM data sets highlight subtleties not appreciated by traditional metabolic biomarkers; this has implications when choosing the most appropriate outcome measures in future research addressing the metabolic impact of PD.
对于腹膜透析（PD）患者，高浓度透析液葡萄糖对腹膜的有害影响已有充分记录。腹膜吸收葡萄糖的全身作用则定义不明确。我们使用连续血糖监测（CGM），旨在描述无糖尿病的 PD 患者的 24 小时血糖谱，并与 5 期慢性肾脏病（CKD-5）的非透析对照者进行比较。
在这项横断面病例对照研究中，15 名 PD 患者（9 名自动化 PD（APD）和 6 名持续非卧床 PD（CAPD））和 16 名 CKD-5 对照者接受了 72 小时 CGM 和代谢谱分析。CGM 用于获得平均葡萄糖浓度和个体内葡萄糖标准差（SD）。数据在整个 72 小时监测期间以及白天（09:00 至 21:00）和夜间（21:00 至 09:00）进行分析。
整个监测期间，三组的平均葡萄糖浓度和个体内葡萄糖 SD 没有差异（≥0.5）。三组的日间平均葡萄糖浓度也相似（=0.729）。APD 夜间的葡萄糖明显高于 CAPD（5.25mmol/L±0.65 vs. 4.28±0.5，=0.026）。CAPD 患者和对照者的夜间葡萄糖明显低于日间平均葡萄糖，而 APD 患者则不存在这种情况。
非糖尿病 APD 和 CAPD 患者观察到系统的血糖模式不同，包括 APD 患者夜间葡萄糖生理性下降缺失。全面的 CGM 数据集突出了传统代谢生物标志物未注意到的细微差别；这在未来研究中选择最适当的结果测量指标以解决 PD 的代谢影响时具有重要意义。
