Hypoalbuminemia in peritoneal dialysis patients

This study aimed to determine the factors that were associated with hypoalbuminemia in peritoneal dialysis (PD) patients. End-stage renal disease patients who had received PD at the National Taiwan University Hospital for more than three months were included and divided into two groups. Patients who had mean serum albumin levels greater or equal to 3.5g/dL were allocated to Group 1, while those who had mean serum albumin levels less than 3.5g/dL were allocated to Group 2. Demographic characteristics, clinical parameters and laboratory data were then compared between the two groups. Logistic regression was also performed to identify the factors that were associated with hypoalbuminemia. There were 359 patients (mean age 54.3 years, male 46.5%) included. Group 2 patients (10.3%) were older (P=0.0536), had lower body mass index (P=0.0008), lower total Kt/V (P=0.0060), and lower levels of hemoglobin (P=0.0268), blood urea nitrogen (P=0.0501), creatinine (P<0.0001), triglyceride (P=0.0014), potassium (P=0.0028), phosphorus (P=0.0036), but higher levels of C-reactive protein (P=0.0194). More Group 2 patients had high or high-average peritoneal equilibration test (PET) (P=0.0199). Using logistic regression, factors that were found to be associated with hypoalbuminemia were total Kt/V (P=0.0015), hemoglobin (P=0.0019), creatinine (P<0.0001), triglyceride (P=0.0060), and potassium (P=0.0126). In conclusion, hypoalbuminemia in our PD patients was associated with total Kt/V as well as levels of hemoglobin, creatinine, triglyceride, and potassium

Glycosylated hemoglobin and albumin-corrected fructosamine are good indicators for glycemic control in peritoneal dialysis patients.

Diabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients.A total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels.There were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P<0.05), AlbF (r = 0.54, P<0.01), and HbA1c (r = 0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7-8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged.HbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates

Demographic data and clinical characteristics of the enrolled diabetic peritoneal dialysis patients.

<p>Continuous ambulatory peritoneal dialysis (CAPD).</p><p>Automated peritoneal dialysis (APD).</p><p>Normalized protein catabolic rate (nPCR).</p

Glucemic change within the first hour of dialysate exchange.

<p>The time course of interstitial fluid (ISF) glucose levels (A), and the change of ISF glucose levels (B) within the first hour of refilling fresh dialysate among different kinds of dialysates, including 1.36%, 2.25%, 3.86% glucose dialysate, and Extraneal.</p

Comparison of ISF glucose concentration change within the first hour of PD fluid exchange between patients with HbA1c levels <8% and ≧8%.

*<p><i>P</i><0.05 with non-parametric <i>t</i>-test.</p><p>Interstitial fluid (ISF).</p

The symbols used to represent the glucose level change by continuous glucose monitoring system.

<p>The symbols used to represent the glucose level change by continuous glucose monitoring system.</p

Glucemic change within the first hour of dialysate exchange.

<p>Within the first hour of peritoneal dialysis (PD) fluid exchange, correlation between Glu0 and (Glu1 h – Glu0)/Glu0 (A) and (Glu0–1 h – Glu0)/Glu0 (B).</p

The change in interstitial fluid glucose concentration within the first hour of peritoneal dialysis fluid exchange among different kinds of dialysates.

*<p><i>P</i><0.05 with non-parametric <i>t</i>-test.</p><p>Glu_{1 h}– Glu₀: Glucose increment at 1 h.</p><p>Glu_{0–1 h}: Mean glucose level within 1 h of fresh dialysate exchange.</p><p>Glu_{0–1 h} – Glu₀: Mean increment of glucose levels within 1 h.</p

Correlation between ISF glucose and glycemic control parameters.

<p>Correlation between 3-day mean interstitial fluid glucose levels measured with continuous glucose monitoring system and levels of single-fasting serum glucose (A), glycated albumin percent (B), fructosamine (C), albumin-corrected fructosamine (D), and glycosylated hemoglobin (E).</p