1
|
Chen YT, Lin CC, Huang PH, Li SY. Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus. J Formos Med Assoc 2024; 123:606-612. [PMID: 38220559 DOI: 10.1016/j.jfma.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Diabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. METHODS We conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. RESULTS Over 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. CONCLUSION Our study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.
Collapse
Affiliation(s)
- Yung-Tai Chen
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; University of Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
2
|
Fernandes MF, Aristizabal-Henao JJ, Marvyn PM, M'Hiri I, Wiens MA, Hoang M, Sebastian M, Nachbar R, St-Pierre P, Diaguarachchige De Silva K, Wood GA, Joseph JW, Doucette CA, Marette A, Stark KD, Duncan RE. Renal tubule-specific Atgl deletion links kidney lipid metabolism to glucagon-like peptide 1 and insulin secretion independent of renal inflammation or lipotoxicity. Mol Metab 2024; 81:101887. [PMID: 38280449 PMCID: PMC10850971 DOI: 10.1016/j.molmet.2024.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE Lipotoxic injury from renal lipid accumulation in obesity and type 2 diabetes (T2D) is implicated in associated kidney damage. However, models examining effects of renal ectopic lipid accumulation independent of obesity or T2D are lacking. We generated renal tubule-specific adipose triglyceride lipase knockout (RT-SAKO) mice to determine if this targeted triacylglycerol (TAG) over-storage affects glycemic control and kidney health. METHODS Male and female RT-SAKO mice and their control littermates were tested for changes in glycemic control at 10-12 and 16-18 weeks of age. Markers of kidney health and blood lipid and hormone concentrations were analyzed. Kidney and blood lysophosphatidic acid (LPA) levels were measured, and a role for LPA in mediating impaired glycemic control was evaluated using the LPA receptor 1/3 inhibitor Ki-16425. RESULTS All groups remained insulin sensitive, but 16- to 18-week-old male RT-SAKO mice became glucose intolerant, without developing kidney inflammation or fibrosis. Rather, these mice displayed lower circulating insulin and glucagon-like peptide 1 (GLP-1) levels. Impaired first-phase glucose-stimulated insulin secretion was detected and restored by Exendin-4. Kidney and blood LPA levels were elevated in older male but not female RT-SAKO mice, associated with increased kidney diacylglycerol kinase epsilon. Inhibition of LPA-mediated signaling restored serum GLP-1 levels, first-phase insulin secretion, and glucose tolerance. CONCLUSIONS TAG over-storage alone is insufficient to cause renal tubule lipotoxicity. This work is the first to show that endogenously derived LPA modulates GLP-1 levels in vivo, demonstrating a new mechanism of kidney-gut-pancreas crosstalk to regulate insulin secretion and glucose homeostasis.
Collapse
Affiliation(s)
- Maria F Fernandes
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | | | - Phillip M Marvyn
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Iman M'Hiri
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Meghan A Wiens
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Monica Hoang
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Manuel Sebastian
- Max Rady College of Medicine, University of Manitoba, Manitoba, Canada
| | - Renato Nachbar
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | - Philippe St-Pierre
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | | | - Geoffrey A Wood
- Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Jamie W Joseph
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | | | - André Marette
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada
| | - Ken D Stark
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Robin E Duncan
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada.
| |
Collapse
|
3
|
Wijewickrama P, Williams J, Bain S, Dasgupta I, Chowdhury TA, Wahba M, Frankel AH, Lambie M, Karalliedde J. Narrative Review of glycaemic management in people with diabetes on peritoneal dialysis. Kidney Int Rep 2023; 8:700-714. [PMID: 37069983 PMCID: PMC10105084 DOI: 10.1016/j.ekir.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
There is an increasing number of people with diabetes on peritoneal dialysis (PD) worldwide. However, there is a lack of guidelines and clinical recommendations for managing glucose control in people with diabetes on PD. The aim of this review is to provide a summary of the relevant literature and highlight key clinical considerations with practical aspects in the management of diabetes in people undergoing PD. A formal systematic review was not conducted because of the lack of sufficient and suitable clinical studies. A literature search was performed using PubMed, MEDLINE, Central, Google Scholar and ClinicalTrials.gov., from 1980 through February 2022. The search was limited to publications in English. This narrative review and related guidance have been developed jointly by diabetologists and nephrologists, who reviewed all available current global evidence regarding the management of diabetes in people on PD.We focus on the importance of individualized care for people with diabetes on PD, the burden of hypoglycemia, glycemic variability in the context of PD and treatment choices for optimizing glucose control. In this review, we have summarized the clinical considerations to guide and inform clinicians providing care for people with diabetes on PD.
Collapse
Affiliation(s)
- Piyumi Wijewickrama
- Department of Diabetes and Endocrinology, University College London Hospital, London, UK
| | - Jennifer Williams
- Department of Renal Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Steve Bain
- Diabetes Research Unit, Swansea University, Swansea, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, Heartlands Hospital Birmingham, Brimingham, UK
| | | | - Mona Wahba
- Department of Renal Medicine, St. Helier Hospital, Carshalton, UK
| | - Andrew H. Frankel
- Department of Renal Medicine, Imperial College Healthcare, London, UK
| | - Mark Lambie
- Department of Renal Medicine, Keele University, Keele, UK
| | - Janaka Karalliedde
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
- Correspondence: Janaka Karalliedde, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London SE1 9NH, UK.
| | | |
Collapse
|
4
|
Chan GCK, Than WH, Kwan BCH, Lai KB, Chan RCK, Teoh JYC, Ng JKC, Chow KM, Cheng PMS, Law MC, Leung CB, Li PKT, Szeto CC. Adipose and Plasma microRNAs miR-221 and 222 Associate with Obesity, Insulin Resistance, and New Onset Diabetes after Peritoneal Dialysis. Nutrients 2022; 14:nu14224889. [PMID: 36432575 PMCID: PMC9699429 DOI: 10.3390/nu14224889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The correlation between microRNA, obesity, and glycemic intolerance in patients on peritoneal dialysis (PD) is unknown. We aimed to measure the adipose and plasma miR-221 and -222 levels, and to evaluate their association with adiposity, glucose intolerance, and new onset diabetes mellitus (NODM) after the commencement of PD. METHODS We prospectively recruited incident adult PD patients. miR-221 and -222 were measured from adipose tissue and plasma obtained during PD catheter insertion. These patients were followed for 24 months, and the outcomes were changes in adiposity, insulin resistance, and NODM after PD. RESULTS One hundred and sixty-five patients were recruited. Patients with pre-existing DM had higher adipose miR-221 (1.1 ± 1.2 vs. 0.7 ± 0.9-fold, p = 0.02) and -222 (1.9 ± 2.0 vs. 1.2 ± 1.3-fold, p = 0.01). High adipose miR-221 and -222 levels were associated with a greater increase in waist circumference (miR-221: beta 1.82, 95% CI 0.57-3.07, p = 0.005; miR-222: beta 1.35, 95% CI 0.08-2.63, p = 0.038), Homeostatic Model Assessment for Insulin Resistance (HOMA) index (miR-221: beta 8.16, 95% CI 2.80-13.53, p = 0.003; miR-222: beta 6.59, 95% CI 1.13-12.05, p = 0.018), and insulin requirements (miR-221: beta 0.05, 95% CI 0.006-0.09, p = 0.02; miR-222: beta 0.06, 95% CI 0.02-0.11, p = 0.002) after PD. The plasma miR-222 level predicted the onset of NODM (OR 8.25, 95% CI 1.35-50.5, p = 0.02). CONCLUSION miR-221 and -222 are associated with the progression of obesity, insulin resistance, and NODM after PD.
Collapse
Affiliation(s)
- Gordon Chun Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-3505-1729; Fax: +852-2637-3852
| | - Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Bonnie Ching Ha Kwan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Ka Bik Lai
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Ronald Cheong Kin Chan
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jeremy Yuen Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jack Kit Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Kai Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Phyllis Mei Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Man Ching Law
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Chi Bon Leung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Philip Kam Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Cheuk Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| |
Collapse
|
5
|
Markova TN, Yavorskaya VO. Prevalence of carbohydrate metabolism disorders in patients with end-stage renal disease on hemodialysis therapy. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There are quite a lot of scientific works today dedicated to the role of disorders carbohydrate metabolism (DCM) in the development of end-stage renal disease (ESRD), at the same time, the influence of chronic kidney disease (CKD) on the development of carbohydrate disorders remains insufficiently studied, especially in patients on renal replacement therapy (RRT). The annual steady increase in the number of patients with ESRD without diabetes mellitus (DM) requiring dialysis therapy leads to increased interest and the need to study carbohydrate status in these patients. It is known that hyperglycemia in patients without DM on hemodialysis (HD) is a predisposing factor to the development of cardiovascular accidents that worsen the quality of life and also increase mortality. The peculiarities of glucose metabolism in patients receiving RRT do not always allow adequate assessment of carbohydrate status using glycated hemoglobin (HbA1c). The review provides up-to-date information on the prevalence of DCM in patients with ESRD without DM receiving HD RRT, touches upon the peculiarities of glucose metabolism, interpretation of HbA1c and glycated albumin values, and mortality risk in hemodialysis patients with various DCM.
Collapse
Affiliation(s)
- T. N. Markova
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov;
Moscow City Hospital 52
| | - V. O. Yavorskaya
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| |
Collapse
|
6
|
Williams J, Gilchrist M, Strain WD, Fraser D, Shore A. 24-h Glycaemic profiles in peritoneal dialysis patients and non-dialysis controls with advanced kidney disease. Perit Dial Int 2021; 42:497-504. [PMID: 34579595 DOI: 10.1177/08968608211047787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND 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). METHODS 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). RESULTS Average glucose concentrations and within-participant SD of glucose for the whole monitoring period were not different between the three groups (p ≥ 0.5). Daytime average glucose concentrations were also similar across the three groups (p = 0.729). APD was associated with a significantly higher nocturnal glucose than CAPD (5.25 mmol/L ± 0.65 vs. 4.28 ± 0.5, p = 0.026). A significant drop in nocturnal glucose compared with daytime average seen in both CAPD patients and controls was absent in APD patients. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Jennifer Williams
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter College of Medicine and Health, UK
| | - Mark Gilchrist
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter College of Medicine and Health, UK
| | - William David Strain
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter College of Medicine and Health, UK
| | | | - Angela Shore
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter College of Medicine and Health, UK
| |
Collapse
|
7
|
Phillips J, Chen JHC, Ooi E, Prunster J, Lim WH. Global Epidemiology, Health Outcomes, and Treatment Options for Patients With Type 2 Diabetes and Kidney Failure. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:731574. [PMID: 36994340 PMCID: PMC10012134 DOI: 10.3389/fcdhc.2021.731574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022]
Abstract
The burden of type 2 diabetes and related complications has steadily increased over the last few decades and is one of the foremost global public health threats in the 21st century. Diabetes is one of the leading causes of chronic kidney disease and kidney failure and is an important contributor to the cardiovascular morbidity and mortality in this population. In addition, up to one in three patients who have received kidney transplants develop post-transplant diabetes, but the management of this common complication continues to pose a significant challenge for clinicians. In this review, we will describe the global prevalence and temporal trend of kidney failure attributed to diabetes mellitus in both developing and developed countries. We will examine the survival differences between treated kidney failure patients with and without type 2 diabetes, focusing on the survival differences in those on maintenance dialysis or have received kidney transplants. With the increased availability of novel hypoglycemic agents, we will address the potential impacts of these novel agents in patients with diabetes and kidney failure and in those who have developed post-transplant diabetes.
Collapse
Affiliation(s)
- Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- *Correspondence: Jessica Phillips,
| | - Jenny H. C. Chen
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Depatment of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Esther Ooi
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Janelle Prunster
- Department of Renal Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
8
|
Chen Y, Dai S, Shang D, Ge X, Xie Q, Hao CM, Zhu T. Effect of -55C/T Polymorphism of Uncoupling Protein 3 Gene on Risk for New-Onset Diabetes in Chinese Peritoneal Dialysis Patients: A Prospective Cohort Study. Blood Purif 2021; 50:857-864. [PMID: 33535204 DOI: 10.1159/000513151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND A high-glucose load in therapy can cause new-onset diabetes (NOD) in peritoneal dialysis (PD) patients. Genetic variability may result in risk modulation. OBJECTIVES This study aims to investigate the association between -55C/T polymorphism of uncoupling protein 3 (UCP3) gene and the risk of NOD in PD patients. METHODS Nondiabetic incident PD patients between May 2005 and January 2017 were recruited (n = 154). -55C/T polymorphism of the UCP3 was genotyped in all participants at baseline. The cohort of wild group (-55CC) and mutant group (-55CT or -55TT) was built based on the genotypic difference. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) during the follow-up. Binary logistic regression was performed to explore the association between HOMA-IR and genotypes. Competitive risk analysis was used to analyze the impact of -55C/T polymorphism of UCP3 on risk for NOD. RESULTS The cohort was followed for up to 164.6 months (median: 58.3 months; interquartile range: 30.7 months). During the follow-up, 14 NODs occurred in the mutant group, while only 3 occurred in the wild group. Patients in the mutant group had higher HOMA-IR (Odd ratio: 2.210; 95% CI: 1.043-4.680; p = 0.038). Genotype with the variant T allele turned out to be an independent predictor for NOD morbidity (HR: 7.639; 95% CI: 1.798-32.451; p = 0.006). CONCLUSIONS The variant of T allele of UCP3 -55C/T polymorphism was an independent predictor for NOD in PD patients. Early identification of the genotype may provide scientific basis for patients' clinic management.
Collapse
Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Da Shang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China,
| |
Collapse
|
9
|
Shi Y, Cai J, Shi C, Liu C, Li Z. Incidence and mortality of new-onset glucose disorders in peritoneal dialysis patients in China: a meta-analysis. BMC Nephrol 2020; 21:152. [PMID: 32349684 PMCID: PMC7191695 DOI: 10.1186/s12882-020-01820-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Dialysis patients are at high risk of developing glucose metabolism disturbances (GMDs), such as diabetes mellitus (DM), impaired fast glucose (IFG), and impaired glucose tolerance (IGT). However, it is unclear about the incidence of GMDs in Chinese patients with peritoneal dialysis (PD), as well as the influence of new-onset DM (NODM) on the prognosis of PD patients. Therefore, we conducted this meta-analysis to address these issues. Methods A comprehensive literature search was conducted using PubMed, Embase, Web of Science, SinoMed, and CNKI database for studies that evaluated the incidence of GMDs and mortality in patients with PD. Results were expressed as hazard ratio (HR), risk ratio (RR), or estimate (ES) with 95% confidence intervals (95%CIs).Meta-analysis was performed using a fixed-effects or random-effects model to pool the estimate. Results Fifteen studies met the inclusion criteria and were included in this meta-analysis. Pooled results showed that, the incidences of NODM, NOIGT, and NOIFG were 12% (95%CI: 9, 15%; P < 0.001), 17% (95%CI: 4, 10%; P < 0.001) and 32% (95%CI: 3, 30%, P < 0.001), respectively. Compared with patients without NODM, PD patients with NODM had an increased risk of mortality (HR = 1.59, 95%CI: 1.28, 1.98; P < 0.001). There was no significant difference in the incidence of NODM between PD and hemodialysis (HD) patients (RR = 1.23, 95%CI: 0.61, 2.51; P = 0.562). Conclusion Dialysis patients in China had an increased risk of developing GMDs, however, the dialysis modality did not have any significant impact on the incidence of NODM. NODM increased the mortality risk in patients undergoing PD. Thus, physicians should pay attention to the plasma glucose level in patients undergoing dialysis.
Collapse
|
10
|
Yarragudi R, Gessl A, Vychytil A. New-Onset Diabetes Mellitus in Peritoneal Dialysis and Hemodialysis Patients: Frequency, Risk Factors, and Prognosis-A Review. Ther Apher Dial 2019; 23:497-506. [PMID: 30854792 PMCID: PMC6916572 DOI: 10.1111/1744-9987.12800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/03/2019] [Accepted: 03/08/2019] [Indexed: 12/23/2022]
Abstract
New-onset diabetes mellitus (NODM) is observed in both hemodialysis (HD) and peritoneal dialysis (PD) patients. The prevalence of NODM in dialysis patients is slightly higher compared to subjects of the general population. Based on currently published data there is no convincing evidence that the risk of NODM is different between HD and PD patients. Data on the effect of glucose load on risk of NODM in dialysis patients remain controversial. PD modality (automated or continuous ambulatory PD) has no significant influence on NODM incidence. Chronic inflammation is associated with NODM in dialysis patients. Reported differences in NODM between PD and HD patients are possibly also influenced by differences in demographic factors between these patient groups. Mortality in NODM patients is lower than mortality in patients with preexisting DM. This may be partly explained by the younger age and lower number of comorbidities in patients with NODM.
Collapse
Affiliation(s)
- Rajashri Yarragudi
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Alois Gessl
- Clinical Division of Endocrinology and Metabolism, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Andreas Vychytil
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
| |
Collapse
|
11
|
Wang IK, Lin CL, Chen HC, Lin SY, Chang CT, Yen TH, Sung FC. Risk of new-onset diabetes in end-stage renal disease patients undergoing dialysis: analysis from registry data of Taiwan. Nephrol Dial Transplant 2019; 33:670-675. [PMID: 28992134 DOI: 10.1093/ndt/gfx250] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background This study compared the risk of developing new-onset diabetes between hemodialysis (HD) and peritoneal dialysis (PD) patients. We further investigated the effectiveness of icodextrin in reducing the risk of new-onset diabetes in PD patients. Methods From the Taiwan health insurance database, 36 879 incident HD patients and 6382 incident PD patients from 2000 to 2010 were identified as study cohorts. We further selected an additional HD cohort matched by propensity scores (PSs) of PD patients. Incidence rates and hazard ratios (HRs) of new-onset diabetes were assessed among cohorts and between icodextrin users and nonusers by the end of 2011. Results For the unmatched cohorts, the incidence of new-onset diabetes was higher in PD patients than in HD patients (9.16 versus 8.18 per 1000 person-years), with an adjusted HR of 1.51 (95% CI 1.30-1.75) for PD patients. For the PS-matched cohorts, the corresponding incidence rates were 9.43 and 5.90 per 1000 person-years, respectively, with an adjusted HR of 1.61 (95% CI 1.32-1.97). Among PD patients, the incidence was lower in icodextrin users than in nonusers (6.22 versus 12.1 per 1000 person-years), with an adjusted HR of 0.66 (95% CI 0.50-0.88) for users. Conclusions Our study suggests that PD patients are at a higher risk of developing new-onset diabetes than HD patients. Icodextrin is recommended for PD patients to reduce the risk of new-onset diabetes.
Collapse
Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chih Chen
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Yi Lin
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan
| |
Collapse
|
12
|
Xue C, Gu YY, Cui CJ, Zhou CC, Wang XD, Ruan MN, Huang LX, Chen SX, Yang B, Chen XJ, Qian YX, Wu J, Zhao XZ, Zhang YQ, Mei CL, Zhang SL, Xu J, Mao ZG. New-onset glucose disorders in peritoneal dialysis patients: a meta-analysis and systematic review. Nephrol Dial Transplant 2019; 35:1412-1419. [PMID: 31236586 DOI: 10.1093/ndt/gfz116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/24/2019] [Indexed: 01/11/2023] Open
Abstract
Abstract
Background
Peritoneal dialysis (PD) patients are at high risk of developing glucose metabolism disturbance (GMD). The incidence and prevalence of new-onset GMD, including diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fast glucose (IFG), after initiation of PD, as well as their correlated influence factors, varies among studies in different areas and of different sample sizes. Also, the difference compared with hemodialysis (HD) remained unclear. Thus we designed this meta-analysis and systematic review to provide a full landscape of the occurrence of glucose disorders in PD patients.
Methods
We searched the MEDLINE, Embase, Web of Science and Cochrane Library databases for relevant studies through September 2018. Meta-analysis was performed on outcomes using random effects models with subgroup analysis and sensitivity analysis.
Results
We identified 1124 records and included 9 studies involving 13 879 PD patients. The pooled incidence of new-onset DM (NODM) was 8% [95% confidence interval (CI) 4–12; I2 = 98%] adjusted by sample sizes in PD patients. Pooled incidence rates of new-onset IGT and IFG were 15% (95% CI 3–31; I2 = 97%) and 32% (95% CI 27–37), respectively. There was no significant difference in NODM risk between PD and HD [risk ratio 0.99 (95% CI 0.69–1.40); P = 0.94; I2 = 92%]. PD patients with NODM were associated with an increased risk of mortality [hazard ratio 1.06 (95% CI 1.01–1.44); P < 0.001; I2 = 92.5%] compared with non-DM PD patients.
Conclusions
Around half of PD patients may develop a glucose disorder, which can affect the prognosis by significantly increasing mortality. The incidence did not differ among different ethnicities or between PD and HD. The risk factor analysis did not draw a definitive conclusion. The glucose tolerance test should be routinely performed in PD patients.
Collapse
Affiliation(s)
- Cheng Xue
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yan-Yan Gu
- Department of Nutrition, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Cheng-Ji Cui
- Department of Nephrology, First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Chen-Chen Zhou
- Department of Nephrology, Yueyang Hospital, Shanghai, China
| | - Xian-Dong Wang
- Department of Internal Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Meng-Na Ruan
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lin-Xi Huang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Si-Xiu Chen
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xu-Jiao Chen
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi-Xin Qian
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xue-Zhi Zhao
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu-Qiang Zhang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Lin Mei
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shou-Lin Zhang
- Department of Nephrology, First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jing Xu
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Guo Mao
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
13
|
Robinski M, Mau W, Wienke A, Girndt M. The Choice of Renal Replacement Therapy (CORETH) project: dialysis patients' psychosocial characteristics and treatment satisfaction. Nephrol Dial Transplant 2018; 32:315-324. [PMID: 28186578 DOI: 10.1093/ndt/gfv464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/25/2015] [Indexed: 11/13/2022] Open
Abstract
Background Until today, research has underestimated the role of psychosocial conditions as contributing factors to dialysis modality choice. The novelty within the Choice of Renal Replacement Therapy (CORETH) project (German Clinical Trials Register #DRKS00006350) is its focus on the multivariate associations between these aspects and their consecutive significance regarding treatment satisfaction (TS) in peritoneal dialysis (PD) versus haemodialysis (HD) patients. In this article, we present the baseline results of a multicentre study, which is supported by a grant from the German Ministry for Education and Research. Methods Six to 24 months after initiation of dialysis, 780 patients from 55 dialysis centres all over Germany were surveyed. The questionnaire addressed psychosocial, physical, socio-demographic and shared decision-making (SDM) aspects. Furthermore, cognitive functioning was tested. After indexing the measures, two propensity score-matched groups (n = 482) were compared in a first step, after having chosen PD or HD. In a second step, a moderated multiple regression (n = 445) was conducted to initially investigate the multivariate impact of patient characteristics on TS. Results In comparison with HD patients, PD patients were more satisfied with their treatment (P < 0.001), had a more autonomy-seeking personality (P = 0.04), had better cognitive functioning (P = 0.001), indicated more satisfying SDM (P < 0.001) and had a larger living space (P < 0.001). All patients were more satisfied when they had a good psychological state and received SDM. Especially in HD patients, TS was higher when the patient had a less autonomous personality, lower cognitive functioning, more social support, a poorer physical state and poorer socio-demographic conditions (R2 = 0.26). Conclusions Psychosocial characteristics play a major role in TS in dialysis patients. Within a multivariate approach, these factors are even more important than physical or environment-related factors. In practice, focusing on SDM and screening patient characteristics at an early stage can foster patients’ TS. Changes will be examined in a 1-year follow-up.
Collapse
Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Internal Medicine II, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
14
|
Abstract
Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute and
- Harborview Medical Center, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Simon J Davies
- Department of Nephrology, Keele University, Staffordshire, United Kingdom; and
| | - David W Johnson
- Department of Nephrology, Division of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| |
Collapse
|
15
|
Peritoneal Dialysate Glucose Load and Systemic Glucose Metabolism in Non-Diabetics: Results from the GLOBAL Fluid Cohort Study. PLoS One 2016; 11:e0155564. [PMID: 27249020 PMCID: PMC4889040 DOI: 10.1371/journal.pone.0155564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/29/2016] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
|
16
|
Rivara MB, Mehrotra R. New-Onset Diabetes in Peritoneal Dialysis Patients - Which Predictors Really Matter? Perit Dial Int 2016; 36:243-6. [PMID: 27230599 DOI: 10.3747/pdi.2015.00251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew B Rivara
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
| |
Collapse
|
17
|
Robinski M, Mau W, Wienke A, Girndt M. Shared decision-making in chronic kidney disease: A retrospection of recently initiated dialysis patients in Germany. PATIENT EDUCATION AND COUNSELING 2016; 99:562-570. [PMID: 26527307 DOI: 10.1016/j.pec.2015.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/25/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare differences in shared decision-making (SDM) and treatment satisfaction (TS) between haemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS 6-24 months after initiation of dialysis, we surveyed 780 patients from throughout Germany (CORETH-project) regarding SDM, the reason for modality choice and TS. Data were compared between two age-, comorbidity-, education-, and employment status-matched groups (n=482). RESULTS PD patients rated all aspects of SDM more positively than did HD patients (total score: MPD=84.6, SD=24.1 vs. MHD=61.9, SD=37.3; p≤0.0001). The highest difference occurred for the item "announcement of a necessary decision" (delta=1.3 points on a 6-point Likert-scale). PD patients indicated their desire for independence as a motivator for choosing PD (65%), whereas HD patients were subject to medical decisions (23%) or wanted to rely on medical support (20%). We found positive correlations between SDM and TS (0.16≤r≤0.48; p≤0.0001). CONCLUSION Our findings increase awareness of a participatory nephrological counseling-culture and imply that SDM can pave the way for quality of life and treatment success for dialysis patients. PRACTICE IMPLICATIONS Practitioners can facilitate SDM by screening patient preferences at an early stage, being aware of biases in consultation, using easy terminology and encouraging passive patients to participate in the choice.
Collapse
Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, University Hospital of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
18
|
Dong J, Yang ZK, Chen Y. Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis. Perit Dial Int 2016; 36:277-83. [PMID: 26847585 DOI: 10.3747/pdi.2015.00182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED ♦ OBJECTIVES To identify predictors of new-onset diabetes and impaired glucose tolerance (IGT) events in patients undergoing peritoneal dialysis (PD) based on baseline and time-dependent covariates, respectively. ♦ METHODS In this prospective, single center-based cohort, all non-diabetic incident PD patients between August 2003 and August 2011 were included. All demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory, dialysis prescription, and nutrition parameters were recorded at regular intervals. Multivariable Cox regression models built from baseline and time-dependent variables respectively were used to calculate the hazard ratio (HR) of potential predictors for new-onset diabetes and IGT (NODI). ♦ RESULTS Of the 612 PD patients, 25 (4.1%) and 7 (1.1%) patients were identified with NODI, respectively, during a mean follow-up period of 32.4 (12.9 - 60.8) months. Using multivariable Cox regression analysis, age and body mass index (BMI) at baseline were significantly associated with NODI after adjustment for potential confounders. During follow-up, time-dependent BMI and serum high-sensitive C-reactive protein (HS-CRP) independently predicted the risk for NODI. Patients with NODI had significantly elevated plasma glucose concentrations and BMI from the start of PD therapy, with serum HS-CRP maintained at high levels. Dietary/dialysate energy intake and other laboratory parameters were not correlated with NODI risk either as baseline or time-dependent variables. ♦ CONCLUSIONS Traditional and uremic-related risk factors, such as older age, higher BMI, and inflammation, contribute to new-onset diabetes and impaired glucose tolerance in PD patients.
Collapse
Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; and Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; and Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| | - Yuan Chen
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; and Key Laboratory of Renal Disease, Ministry of Education; Beijing, China
| |
Collapse
|
19
|
Chou CY, Wang SM, Liang CC, Chang CT, Liu JH, Wang IK, Hsiao LC, Muo CH, Chung CJ, Huang CC. Peritoneal Dialysis is Associated With A Better Survival in Cirrhotic Patients With Chronic Kidney Disease. Medicine (Baltimore) 2016; 95:e2465. [PMID: 26825885 PMCID: PMC5291555 DOI: 10.1097/md.0000000000002465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HD patients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P < 0.01) after adjustments for confounders. The severity of liver cirrhosis defined by Child-Turcotte-Pugh (CTP) class (P < 0.01) was independently associated with all-cause mortality. The model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P < 0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels.
Collapse
Affiliation(s)
- Che-Yi Chou
- From the Division of Nephrology and Kidney Institute, Department of Internal Medicine (C-CY, W-SM, L-CC, C-CT, L-JH, W-IK, H-CC); College of Medicine (C-CY, W-SM, L-CC, C-CT, L-JH, W-IK, H-LC, H-CC); Division of Cardiology, Department of Internal Medicine China Medical University Hospital (H-LC); Department of Public Health (M-CH); Management Office for Health Data, China Medical University and Hospital, 91 Hsueh-Shih Road (M-CH); Department of Health Risk Management, College of Public Health (C-CJ); and Department of Medical Research, China Medical University Hospital, Taichung 40402, Taiwan (C-CJ)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Chen HC, Chou CY, Hsiao YT, Liang CC, Kuo HL, Chang CT, Liu JH, Wang IK, Huang CC. Patients with diabetes as the primary kidney disease have a worse survival than patients with comorbid diabetes in chronic haemodialysis patients. Nephrology (Carlton) 2015; 20:155-60. [PMID: 25487855 DOI: 10.1111/nep.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Hung-Chih Chen
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
| | - Che-Yi Chou
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Yi-Tzone Hsiao
- Biostatistics Center; China Medical University; Taichung Taiwan
| | - Chih-Chia Liang
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Huey-Liang Kuo
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Chiz-Tzung Chang
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Jiung-Hsiun Liu
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - I-Kuan Wang
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Chiu-Ching Huang
- Kidney Institute and Division of Nephrology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| |
Collapse
|
21
|
YANG JUN, ZHU TIECHUI, LIU XIANGDONG, ZHANG LIANYUN, YANG YUXIN, ZHANG JIE, GUO MINGHAO. Heat shock protein 70 protects rat peritoneal mesothelial cells from advanced glycation end-products-induced epithelial-to-mesenchymal transition through mitogen-activated protein kinases/extracellular signal-regulated kinases and transforming growth factor-β/Smad pathways. Mol Med Rep 2015; 11:4473-81. [DOI: 10.3892/mmr.2015.3271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 12/12/2014] [Indexed: 11/05/2022] Open
|