Original Investigation
Dialysis
New-Onset Hyperglycemia in Nondiabetic Chinese Patients Started on Peritoneal Dialysis

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Background

Glucose has been used as the osmotic agent added to standard peritoneal dialysis (PD) solutions since its inception. Patients who have no history of glucose intolerance may develop hyperglycemia after the initiation of PD therapy. However, the prevalence and long-term implications of new-onset hyperglycemia in PD patients has not been studied.

Methods

We studied 405 consecutive patients with renal failure newly started on PD therapy. Fasting plasma glucose levels 1 month after being stable on PD therapy were reviewed. Clinical factors affecting fasting plasma glucose levels were explored. Patients were followed up for 49.7 ± 28.4 months.

Results

Of 405 patients, 136 had underlying diabetic nephropathy and another 17 had preexisting diabetes before starting PD therapy. Of the remaining 252 patients, fasting plasma glucose levels were greater than 200 mg/dL (>11.1 mmol/L) in 21 (8.3%) and 126 to 200 mg/dL (7.0 to 11.1 mmol/L) in 48 patients (19.0%). Seven patients required insulin therapy, 3 required low-dose sulfonylurea therapy, and all other patients had glucose levels controlled by means of dietary restriction only. Fasting plasma glucose levels significantly correlated with patient age (Pearson r = 0.278; P < 0.001), Charlson comorbidity score (r = 0.484; P < 0.001), baseline serum C-reactive protein level (r = 0.390; P < 0.001), and serum albumin level (r = −0.182; P < 0.001). However, patients with new-onset hyperglycemia had similar values for body weight, body mass index, peritoneal transport parameters, and ultrafiltration profile compared with other patients. At 36 months, actuarial survival rates were 93.7%, 85.3%, 81.6%, and 66.7% for patients with fasting glucose levels less than 100, 100 to less than 126, 126 to less than 200, and 200 mg/dL or greater (5.6, 5.6 to <7.0, 7.0 to <11.1, and ≥11.1 mmol/L) and 65.9% for patients with preexisting diabetes, respectively (overall log rank test, P < 0.001).

Conclusion

New-onset hyperglycemia is common in patients without diabetes started on PD therapy. Contrary to common belief, obese patients do not appear to have a greater risk of hyperglycemia. Our results suggest that even mild hyperglycemia, with fasting plasma glucose level greater than 100 mg/dL (>5.6 mmol/L), is associated with worse survival in PD patients.

Section snippets

Patient Selection

We studied 405 unselected Chinese patients newly started on continuous ambulatory PD in the dialysis unit of a single university hospital in Hong Kong from 1998 to 2004. Baseline data, including age, sex, underlying renal disease, previous fasting blood test, and PD regimen, were recorded. Comorbid conditions, including coronary artery disease, heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disorder, peptic ulcer

Prevalence of New-Onset Hyperglycemia

We studied 405 patients. There were 136 patients with underlying diabetic nephropathy, and another 17 patients had preexisting diabetes before starting PD therapy. One of these patients had type 1, whereas all the others had type 2 diabetes. Average duration of diabetes before dialysis therapy was 9.5 ± 4.9 years. Thirty-five patients (22.9%) had symptomatic diabetic neuropathy at the initiation of dialysis therapy, 79 (51.6%) had documented retinopathy, and 59 (38.6%) had a history of laser

Discussion

In the present series, we find that fasting plasma glucose levels were greater than 200 mg/dL (>11.1 mmol/L) in 4.4% of PD patients without diabetes. The prevalence was remarkably similar to that of de novo diabetes reported in the published literature.9, 10 However, another 19% of our patients had a fasting plasma glucose level of 126 to 200 mg/dL (7.0 to 11.1 mmol/L). Our finding indicates that a milder degree of hyperglycemia is not uncommon in PD patients. In comparison, a previous study

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    Originally published online as doi:10.1053/j.ajkd.2007.01.018 on March 1, 2007.

    Support: CUHK research account 6901031. Potential conflicts of interest: None.

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