High Peritoneal Permeability Predisposes to Hepatic Steatosis in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients Receiving Intraperitoneal Insulin

2000 ◽  
Vol 20 (6) ◽  
pp. 637-642 ◽  
Author(s):  
Pasi I. Nevalainen ◽  
Timo Kallio ◽  
Jorma T. Lahtela ◽  
Jukka Mustonen ◽  
Amos I. Pasternack
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Insulin Dose ◽  
Tertiary Care ◽  
University Hospital ◽  
Diabetic Patients ◽  
Fat Accumulation ◽  
Hepatic Fat ◽  
Intraperitoneal Insulin

Objective To evaluate hepatic fat accumulation in diabetic patients taking intraperitoneal or subcutaneous insulin treatment during continuous ambulatory peritoneal dialysis (CAPD). Design Cross-sectional study. Setting Tertiary-care university hospital. Patients We studied 16 patients with diabetic end-stage renal disease currently treated with CAPD. Median age was 42 years (range: 34 – 70 years), duration of diabetes was 27.5 years (range: 17 – 39 years), and duration of CAPD was 16.5 months (range: 2 – 59 months). Outcome Measures Ultrasound measures of liver steatotic area and thickness, peritoneal equilibration test (PET), weekly Kt/V urea, protein catabolic rate (PCR), hemoglobin A1c (HbA1c), lipoproteins, alanine aminotransferase, alkaline phosphatase, insulin dose, and dialysate glucose load. Results Focal hepatic fat accumulation was found. The location of steatosis was subcapsular; a negligible amount was periportal. Hepatic subcapsular steatosis was present in 7 of 8 patients taking insulin intraperitoneally and in 0 of 8 patients taking insulin subcutaneously. The maximal thickness of subcapsular steatosis correlated directly with peritoneal transport rate (2-hour dialysate-to-plasma creatinine ratio in PET, r = 0.80, p < 0.05) and inversely with PCR ( r = –0.82, p < 0.05). The area of the lesions correlated directly with body weight ( r = 0.80, p < 0.05) and inversely with weekly Kt/V urea ( r = –0.90, p < 0.01). Conclusions Intraperitoneal insulin, together with glucose-based peritoneal dialysate, induces hepatic subcapsular steatosis. The amount of hepatic subcapsular steatosis increases when peritoneal transfer rate and body weight are high.

Minimizing the Drainage Period for Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Kazuo Kumano ◽  
Shinji Yokota ◽  
Tadasu Sakai ◽  
Haruki Kazama ◽  
Katsuyoshi Sofue
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Tertiary Care ◽  
University Hospital ◽  
Contact Period ◽  
Drainage Flow ◽  
Positive Linear Correlation ◽  
Molecular Substances

Objectives To examine features of drainage flow and to determine whether the drainage period could be safely reduced in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Open nonrandomized prospective study in CAPD patients. Setting The kidney center in a tertiary care university hospital. Patients Fourteen CAPD patients with good catheter function. Interventions Drainage flow pattern was studied using a 2-L dialysate. The drainage period was reduced from 28 minutes (mean) to 10 minutes throughout a short-term, 2-month study period and a long-term, 6-month study period for 10 patients. Main Outcome Measures Ultrafiltration volume, body weight, and peritoneal clearance. Results A kinetics analysis of the drainage period and volume indicated a positive linear correlation with two different slopes: one for rapid drainage for the first 5–7 minutes and one for subsequent slow drainage. The effluent exceded 80% in the former period. Ultrafiltration volume and body weight showed no change due to the reduction. Improved peritoneal clearance of small molecular substances could not be confirmed despite a 5% increase in the effective dialysis period. Nearly all patients were satisfied with the reduction and desired its continuation. Conclusions Ten minutes is a sufficient drainage period for most CAPD patients with a 2-L dialysate volume. This may possibly allow an increase in daily activities and an effective peritoneal membrane dialysate contact period.

The Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 16-20 ◽  
Author(s):  
C.T. Flynn
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Term Survival ◽  
Basic Issue ◽  
Insulin Dependent ◽  
Intraperitoneal Insulin ◽  
Insulin Dependent Diabetic

Insulin-dependent diabetics with renal failure have a relatively poor long-term survival. The basic issue, therefore, is quality of life. CAPD allows the patient to be independent. The procedure can be performed as well by the blind as by a sighted patient and thus is available to blind diabetics. Intraperitoneal insulin offers a safe, consistent and convenient control of the blood sugar. Our experience suggests that continuous ambulatory peritoneal dialysis is the dialytic treatment of choice for the majority of insulin-dependent diabetic patients.

Intraperitoneal Insulin Reduces Plasma Leptin Concentration in Diabetic Patients on CAPD

2000 ◽  
Vol 20 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Pasi I. Nevalainen ◽  
Jorma T. Lahtela ◽  
Jukka Mustonen ◽  
Amos Pasternack
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
University Hospital ◽  
Glucose Disposal ◽  
Diabetic Patients ◽  
Type I ◽  
Intraperitoneal Insulin ◽  
End Stage ◽  
Plasma Leptin ◽  
Glucose Disposal Rate

Objective To determine the effects of subcutaneous (SC) and intraperitoneal (IP) insulin on serum leptin concentration in type I diabetic patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD). Design Prospective, open, before–after study. Setting Tertiary-care university hospital. Participants Twelve type I diabetic patients with stabilized CAPD, age 43.9 ± 2.8 years, and duration of diabetes 30.4 ± 3.5 years. Intervention After stabilized CAPD therapy, all patients were treated first with SC insulin for a median of 3 months, and thereafter with IP insulin for another 3 months. Main Outcome Measures Plasma leptin, insulin sensitivity with euglycemic clamp, and glycemic and uremic status after both treatment periods. Results During SC insulin therapy, plasma leptin concentration was significantly higher than during IP insulin (19.8 ± 5.9 ng/mL and 12.8 ± 6.2 ng/mL, respectively; p < 0.001). Leptin concentration was higher in CAPD patients and was related to body mass index in both genders. No correlation was detected between plasma leptin and fasting insulin, glycemic control, glucose disposal rate, or serum lipids. Conclusion Plasma leptin concentration is lower during IP insulin therapy compared to SC insulin. Insulin has probably a direct effect on both peritoneal leptin clearance and adipose tissue leptin production. The significance of leptin in regulating appetite and anorexia in uremia remains unclear.

Intraperitoneal Insulin Cannot Correct the Hyperlipidemia of CAPD

1983 ◽  
Vol 3 (3) ◽  
pp. 126-127 ◽  
Author(s):  
Stephen F. Beardsworth ◽  
Henry J. Goldsmith ◽  
Brent R. Stanbridge
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Glucose ◽  
Total Cholesterol ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Significant Lowering ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Small Doses ◽  
Intraperitoneal Insulin

We have investigated the effect of the administration of small doses of intraperitoneal insulin (mean 2.7 ± 1.45 u/L) on the hyperlipidemia associated with continuous ambulatory peritoneal dialysis (CAPD) in nine non-diabetic patients. Despite significant lowering of both fasting (6.21 ± 0.9 → 4.2 ± 0.5 mmoI/L) and postprandial (9.74 ± 1.1 → 7.4 ± 1.06 mmol/L) blood glucose levels, we saw no effect on serum total cholesterol, triglycerides or B lipoproteins.

Nutritional Status of Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

1983 ◽  
Vol 3 (3) ◽  
pp. 138-141 ◽  
Author(s):  
Brigitte Heide ◽  
Andreas Pierratos ◽  
Ramesh Khanna ◽  
Jean Pettit ◽  
Raymond Ogilvie ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Biochemical Parameters ◽  
Total Body Potassium ◽  
Total Body ◽  
Over Time

Nutritional follow-up of 20 CAPD patients for 18–24 months showed a decrease in total body nitrogen, increase in total body potassium and body weight, and a decrease in protein intake over time. There was no correlation between changes in TBN and the biochemical parameters measured. Serial dietetic assessments and measurements of total body nitrogen as well as adherence to an adequate protein intake will assist in the prevention of malnutrition in CAPD patients.

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

1980 ◽  
Vol 1 (5) ◽  
pp. 54-58 ◽  
Author(s):  
Norbert H. Lameire ◽  
Marc De Paepe ◽  
Raymond Vanholder ◽  
Johan Verbanck ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Average Rate ◽  
Sodium Concentration ◽  
Risk Category ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

Variability of Peritoneal Protein Loss in Diabetic and Nondiabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 242-244 ◽  
Author(s):  
Sophia Spaia ◽  
Fotini Christidou ◽  
Panayotis Pangidis ◽  
Thomas Tsoulkas ◽  
Michalis Pazarloglou ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Protein ◽  
Peritoneal Fluid ◽  
Protein Loss ◽  
Glucose Levels ◽  
Short Period ◽  
Group A ◽  
Group B

In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months. In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid. We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL). Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02). Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL). Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment. We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.

Peritoneal Absorption of Vancomycin during and after Resolution of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients

1988 ◽  
Vol 8 (2) ◽  
pp. 135-136 ◽  
Author(s):  
B. Bastani ◽  
D. A. Spyker ◽  
F. B. Westervelt
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Half Life ◽  
Loading Dose

We studied the absorption of i.p. loading dose of vancomycin (30 mg/kg of body weight) in five continuous ambulatory peritoneal dialysis (CAPD) patients, both at the time of peritonitis and after its resolution. Mean vancomycin absorption after 6 h of i.p. dwell was 74% from inflamed and 51% from noninflamed peritoneum. Mean peritoneal absorption half-life of vancomycin was 3.2 and 7.2 h in the inflamed vs. non inflamed peritoneum, respectively.

Effects of Oral Glucose on Intermediary Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients versus Healthy Subjects

1998 ◽  
Vol 18 (5) ◽  
pp. 505-511 ◽  
Author(s):  
Jacques Delarue ◽  
Claude Maingourd ◽  
Charles Couet ◽  
Sophie Vidal ◽  
Philippe Bagros ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Lipid Oxidation ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Healthy Subjects ◽  
Tertiary Care ◽  
Substrate Oxidation ◽  
Oral Glucose ◽  
Dialysis Unit ◽  
Nonesterified Fatty Acids

Objective To explore the mechanisms and metabolic consequences of the insulin resistance of patients treated by continuous ambulatory peritoneal dialysis (CAPD). Design CAPD patients and healthy subjects ingested a similar mean oral glucose load per kilogram of fat-free mass (FFM) [1.20 ± 0.03 g/(kg FFM) vs 1.20 ± 0.06 g/(kg FFM); CAPD vs healthy subjects]. Substrate oxidation was monitored over 6 hours using indirect calorimetry. Setting Peritoneal dialysis unit of a tertiary-care institutional center. Outcome Measures Glycemia, insulinemia, substrate oxidation. Patients Six CAPD patients (68 ± 5 yr) and 6 healthy subjects (24 ± 1 yr). The CAPD patients had similar body mass index (21.4 ± 1.3 vs 22.9 ± 1.1 kg/m2), a higher percent fat (25.8% ± 3.7% vs 16% ± 2.2%; p < 0.05), and a lower FFM (42.2 ± 2.2 kg vs 56.5 ± 2.6 kg; p < 0.01) than healthy subjects. Results The CAPD patients displayed a higher glycemic and insulinemic responses to glucose than did healthy subjects (p < 0.05), but similar glucose oxidation and storage. Lipid oxidation and plasma nonesterified fatty acids were not increased in CAPD patients versus healthy subjects, in spite of a higher adiposity. Fat oxidation was related to fat mass in CAPD patients (r2 = 0.77, p < 0.05) but not in healthy subjects (r2 = 0.05). Conclusion CAPD patients display an insulin -resistance not explained by an increased lipid oxidation. The maintenance of intracellular glucose utilization at the expense of higher glycemic and insulinemic responses suggests a defective glucose transport.

Sign in / Sign up

Export Citation Format

Share Document