Randomized, Controlled Trial of Glucose-Sparing Peritoneal Dialysis in Diabetic Patients

Title
Randomized, Controlled Trial of Glucose-Sparing Peritoneal Dialysis in Diabetic Patients
Author(s)
도준영Philip K.T. Li[Philip K.T. Li]Bruce F. Culleton[Bruce F. Culleton]Amaury Ariza[Amaury Ariza]David W. Johnson[David W. Johnson]Mauricio Sanabria[Mauricio Sanabria]Ty R. Shockley[Ty R. Shockley]Ken Story[Ken Story]Andrey Vatazin[Andrey Vatazin]Mauro Verrelli[Mauro Verrelli]Alex W. Yu[Alex W. Yu]Joanne M. Bargman[Joanne M. Bargman]
Keywords
PREDIALYSIS GLYCEMIC CONTROL; CHRONIC KIDNEY-DISEASE; MAINTENANCE HEMODIALYSIS; ICODEXTRIN IMPROVES; INSULIN-RESISTANCE; METABOLIC SYNDROME; GLYCATED ALBUMIN; FLUID MANAGEMENT; CAPD PATIENTS; MORTALITY
Issue Date
201311
Publisher
AMER SOC NEPHROLOGY
Citation
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, v.24, no.11, pp.1889 - 1900
Abstract
Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months. Combining both studies, 251 patients were allocated to control (n=127) or intervention (n=124) across 11 countries. The primary endpoint was change in glycated hemoglobin from baseline. Mean glycated hemoglobin at baseline was similar in both groups. In the intention-to-treat population, the mean glycated hemoglobin profile improved in the intervention group but remained unchanged in the control group (0.5% difference between groups; 95% confidence interval, 0.1% to 0.8%; P=0.006). Serum triglyceride, very-low-density lipoprotein, and apolipoprotein B levels also improved in the intervention group. Deaths and serious adverse events, including several related to extracellular fluid volume expansion, increased in the intervention group, however. These data suggest that a low-glucose dialysis regimen improves metabolic indices in diabetic patients receiving peritoneal dialysis but may be associated with an increased risk of extracellular fluid volume expansion. Thus, use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status.
URI
http://hdl.handle.net/YU.REPOSITORY/28460http://dx.doi.org/10.1681/ASN.2012100987
ISSN
1046-6673
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의과대학 > 내과학교실 > Articles
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