EFFECT OF DIABETES AND PERITONITIS ON THE PERITONEAL EQUILIBRATION TEST

Peritoneal equilibration tests (PET) were performed on 47 patients (15 diabetics) who had been on CAPD for 1 to 112 months. Among new patien ts on CAPD (1 to 3 months) with no history of peritonitis, diabetics h ad higher D/P/(Cr) than non-diabetics (P < 0.02). However, after 57 mo nths of CAPD, in patients with less than or equal to 2 episodes of per itonitis, glucose and creatinine transport rates were lower (P < 0.05) in diabetic than nondiabetic patients. Among patients on CAPD for gre ater than or equal to 7 months, creatinine (P < 0.05) and glucose tran sport (P < 0.01) were higher in patients with a history of greater tha n or equal to 3 episodes of peritonitis than in those with less than o r equal to 2 episodes. Drain volumes did not differ between any of the subgroups (all P > 0.05). The observations in patients newly establis hed on CAPD were substantiated in a larger study of 55 non-diabetic an d 35 non-insulin dependent diabetic patients. D/D-0 glucose correlated with plasma glucose (r = 0.40, P < 0.02) in the diabetic group. Net u ltrafiltration was reduced in hyperglycemic (P = 0.022) but not normog lycemic diabetics (non-diabetics 231 +/- 167 ml hyperglycemic diabetic s 127 +/- 177 ml, normoglycemic diabetics 238 r 159 ml). Creatinine cl earance was higher in normoglycemic (P = 0.02) but not hyperglycemic d iabetics (non-diabetics 6.8 +/- 0.9 ml/min, hyperglycemic diabetics 6. 9 +/- 0.8 ml/min, normoglycemic diabetics 7.4 +/- 0.7 ml/min). These d ata show that diabetes and peritonitis incidence should be borne in mi nd when interpreting results of the PET. We conclude that peritoneal m embrane transport differs in non-insulin dependent diabetic patients a nd that ultrafiltration win be lower than is achievable in non-diabeti c patients with the same glucose transport rate unless normoglycemia i s maintained.