Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients

Li, Philip K.T., Culleton, Bruce F., Ariza, Amaury, Do, Jun-Young, Johnson, David W., Sanabria, Mauricio, Shockley, Ty R., Story Ken, Vatazin, Andrey, Verrelli, Mauro, Yu, Alex W. and Bargman, Joanne M. (2013) Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients. Journal of the American Society of Nephrology, 24 11: 1889-1900. doi:10.1681/ASN.2012100987

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Author Li, Philip K.T.
Culleton, Bruce F.
Ariza, Amaury
Do, Jun-Young
Johnson, David W.
Sanabria, Mauricio
Shockley, Ty R.
Story Ken
Vatazin, Andrey
Verrelli, Mauro
Yu, Alex W.
Bargman, Joanne M.
Title Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients
Journal name Journal of the American Society of Nephrology   Check publisher's open access policy
ISSN 1046-6673
1533-3450
Publication date 2013-11-01
Year available 2013
Sub-type Article (original research)
DOI 10.1681/ASN.2012100987
Open Access Status DOI
Volume 24
Issue 11
Start page 1889
End page 1900
Total pages 12
Place of publication Washington, DC United States
Publisher American Society of Nephrology
Language eng
Formatted 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 andamino acids) and followed for 6 months. Combiningboth 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.
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Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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