We are incorporating a diabetes educator into our PD clinic. She says she could only find three articles on the effects of glucose based dialysis solution on diabetics. Are you aware of any good studies or information regarding this subject? Thank you so much,

Questions About PD

Julia S, Nurse from Kelowna General Hospital asked
We are incorporating a diabetes educator into our PD clinic. She says she could only find three articles on the effects of glucose based dialysis solution on diabetics. Are you aware of any good studies or information regarding this subject? Thank you so much,

1 answer

Nurse, Canada, Doctor, Canada February 10, 2019

We thank you for your question. We answered a similar question of the ISPD website a while ago concerning the effect of a 2.5% glucose PD solution on a PD patient with diabetes. This was my response (see below), with much help from a renal dietitian, plus a nephrologist from Canada added her thoughts in the second response.

“A 2.5% PD solution will contain 25 g of dextrose per liter. Therefore a 2 L 2.5% solution will contain 50 g of dextrose. Now, in general, the amount of glucose absorbed by the patient is approximately 50–70% ― depends on short or long dwells (longer dwells, more dextrose absorbed) and type of peritoneal membrane determined by the PET (fast transporter, greater dextrose absorption). Thus, a 2.5% PD solution could contribute anywhere from 25–35 g dextrose per 2 L exchange with CAPD and the absorption and impact on blood sugar will vary depending on the patient.

Please understand that the amount absorbed by a diabetic patient on PD from a 2.5% solution is very individual. For example, other variables such as stress, infection, food intake, medications all impact the changes in blood glucose and response to the dextrose in the solution.
If you have access to a renal dietitian, she or he should well be able to help you manage your patient’s nutritional requirements, taking into account the PD solutions the patient is using each day.”

Zuo X et al. Glucose absorption in nephropathy patients receiving continuous ambulatory peritoneal dialysis. Asia Pac J Clin Nutr 2015; 24(3):394-402.

AskTheExpertTeam  Doctor (Canada) ⋅ March 6, 2018

As mentioned in the other response, the higher the concentration of dextrose, the greater the likelihood of glucose absorption systemically. If the patient is frequently requiring 2.5% solutions to maintain UF, one could consider adding icodextrin for one exchange daily as icodextrin will not contribute to hyperglycemia, and it’s ability to optimize UF will allow for use of lower % dextrose solutions for the other exchanges.

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