Clinical and biochemical characteristics of type 2 diabetic patients on continuous ambulatory peritoneal dialysis: Relationships with insulin requirement

Although glycemic control has an important impact on the clinical outcomes of patients with diabetes undergoing dialysis, there is a paucity of data o n the relationship between glucose metabolism and clinical parameters in th ese patients. In this study, we compared a cohort of 48 patients with type II diabetes undergoing continuous ambulatory peritoneal dialysis (CAPD) wit h 84 age- and sex-matched patients with type II diabetes with similar disea se duration but normal renal function. Compared with those with normal rena l function, patients with type 2 diabetes undergoing CAPD had greater serum angiotensin-converting enzyme activity (median, 57.4 U/L; range, 33.5 to 1 00.0 U/L v 46.9 U/L; range, 11.6 to 111.2 U/L; P < 0.005), fasting C-peptid e (median, 9.1 ng/mL; range, 0.9 to 30.0 ng/mL v 2.2 ng/mL; range, 0.2 to 2 0.3 ng/mL; P < 0.0001) and triglyceride levels, and lower serum albumin con centrations. Among the patients undergoing CAPD, there was a preponderance of men in the insulin-treated group. Insulin-treated patients also had grea ter plasma albumin levels and body weights and lower fasting serum C-peptid e levels (2.81 +/- 1.77 v 3.12 +/- 2.04 ng/mL; analysis of variance, P = 0. 007 adjusted for fasting glucose concentration). Multivariate analysis show ed duration of diabetes, hemoglobin A(1c) (HbA(1c)) level, and body weight were independent determinants of insulin requirement in patients undergoing CAPD. The daily Insulin dosage required was related to the duration of dia betes (r = 0.5; P = 0.007). In summary, among patients with end-stage renal failure, insulin-treated patients had greater body weights and plasma albu min levels but lower cholesterol levels. Plasma C-peptide concentration and duration of diabetes were the main determinants of Insulin requirement, re flecting a decrease In beta-cell reserve, whereas the daily insulin dose co rrelated mainly with body weight, HbA(1c) level, and duration of diabetes. KW had no effect on insulin resistance or insulin requirement of the patien ts. (C) 1999 by the National Kidney Foundation, Inc.