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NDT Advance Access published online on July 7, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn384
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Acute central haemodynamic effects induced by intraperitoneal glucose instillation

Anneleen Pletinck1, Francis Verbeke1, Luc Van Bortel2, Clement Dequidt1, Denise Vijt1, Wim Van Biesen1 and Raymond Vanholder1

1 Renal Division, Department of Internal Medicine, Ghent University Hospital 2 Heymans Institute of Pharmacology, Ghent University, Belgium

Correspondence and offprint requests to: Wim Van Biesen, Renal Division, Department of Internal Medicine, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium. Tel: +32-9-2404509; Fax: +32-9-2404599; E-mail: wim.vanbiesen{at}ugent.be



  Abstract

Background. The supposed lack of a haemodynamic impact of peritoneal dialysis (PD) has been challenged recently by the finding of a mild increase of peripheral blood pressure (BP) during an acute dwell. It is not clear whether, besides the effect of changes in intraperitoneal (IP) volume and/or pressure, IP glucose instillation and absorption plays a role in this. Therefore, we tested the impact of IP instillation of glucose on the evolution of central haemodynamic parameters, using SphygmoCor®, during an acute dwell with two different glucose concentrations.

Methods. Stable, non-diabetic PD patients (N = 22) were treated consecutively in a randomized, cross-over design (A then B or B then A) with one 1.36% (A) and one 3.86% (B) physioneal dwell of 100 min. Central BP was measured with SphygmoCor® and blood was sampled for serum glucose and insulin levels every 20 min. Insulin resistance was defined as a Homeostatic Model Assessment Index (HOMA-index) >1.4.

Results. Serum glucose levels rose during both the 1.36% and the 3.86% dwell, whereas insulin levels rose only during the 3.86% dwell. The increase of both glucose and insulin levels was more pronounced in patients with insulin resistance (11/22 patients). There was, however, no accompanying change versus baseline in haemodynamic parameters (carotid systolic blood pressure, diastolic BP, heart rate or augmentation index).

Conclusion. Despite substantial increases in blood glucose and insulin levels, there was no accompanying change in central haemodynamic parameters during an acute PD dwell with low or high glucose concentrations.

Keywords: central blood pressure; glucose; haemodynamic; peritoneal dialysis; tonometry

Received for publication: 15. 5.08
Accepted in revised form: 16. 6.08


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