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Peritoneal dialysate glucose load and systemic glucose metabolism in non-diabetics: results from the GLOBAL fluid cohort study

Guerrero-Romero, Fernando, 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, Nicholas and Davies, Simon John 2016. Peritoneal dialysate glucose load and systemic glucose metabolism in non-diabetics: results from the GLOBAL fluid cohort study. PLoS ONE 11 (6) , e0155564. 10.1371/journal.pone.0155564

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Background and Objectives 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. Methods and Materials 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. Results 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 <6, Incident group HR 0.92, 95%CI 0.58, 1.46, Prevalent group HR 1.42, 95%CI 0.86, 2.34). Conclusions In prevalent non-diabetic patients, random glucose levels at a diabetic level are under-recognised and increase with dialysate glucose load. Random glucose levels predict mortality in unadjusted analyses, but this association has not been proven in adjusted analyses.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Public Library of Science
ISSN: 1932-6203
Date of Acceptance: 29 April 2016
Last Modified: 05 Feb 2020 04:24

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