Blood Glucose and Cholesterol Control Improved by Continuous Ambulatory Peritoneal Dialysis in Patients with End-Stage Renal Disease and Diabetes Mellitus

Abstract

This longitudinal study was performed to evaluate the change of total cholestererol, triglycerides, and glucose control in patients with insulin-dependent diabetes mellitus (IDDM) and end-stage renal disease (ESRD) during predialysis (PreD), on continuous ambulatory peritoneal dialysis (CAPD) and after kidney graft. A total of 20 consecutive patients (7 women, 13 men, mean age 42 years) with IDDM and ESRD were studied retrospectively in 1991 during PreD and during CAPD. Twelve were also investigated after obtaining a kidney graft. Insulin was administered Intraperitoneally (CAPD period) and subcutaneously (PreD and transplant). The mean values of weight, serum albumin, glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerldes were calculated during each period. Patients were age and sex-matched with a group of healthy controls (Group 1) and with a group of patients with IDDM without nephropathy (Group 2). T-test statistics were used. During CAPD, there were significant decreases in HbA1c (mean 8.1 mmol/L vs 12.1, p=0.003) and cholesterol (mean 6.1 mmol/L vs 7.1, p=0.025) compared to PreD. No differences were found between PreD and CAPD stages with regard to weight, serum albumin, or triglycerides. After transplantation an improvement was found In serum albumin compared to PreD and CAPD (mean value 40 g/L.vsvs 34 and 35, p<0.03), and HbA1c compared to PreD (9.6 mmol/L vs 12.1, p=0.014), if the pancreas transplanted were included. Patients compared to Group 1 or 2 showed no differences in total cholesterol or triglycerldes. HbA1c was higher in patients during PreD than in Group 2. Peritoneal dialysis may not be a poor alternative for glucose and total cholesterol control in diabetic patients with ESRD. Transplantation further Improves serum albumin.