Peritoneal Dialysate Glucose Load and Systemic Glucose Metabolism in Non-Diabetics: Results from the GLOBAL Fluid Cohort Study
- Authors
- 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, Nick; Davies, Simon John
- Issue Date
- 1-Jun-2016
- Publisher
- Public Library of Science
- Keywords
- Peritoneal Dialysate Glucose Load and Systemic Glucose Metabolism in Non-Diabetics: Results from the GLOBAL Fluid Cohort Study.
- Citation
- PLoS ONE, v.11, no.6
- Journal Title
- PLoS ONE
- Volume
- 11
- Number
- 6
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/9023
- DOI
- 10.1371/journal.pone.0155564
- ISSN
- 1932-6203
- 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 (beta = -0.007, 95% CI -0.010, -0.004) and decreased with higher serum sodium (beta = 0.002, 95% CI 0.0005, 0.003) in incident patients and increased with dialysate glucose (beta = -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.
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
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