Serlie MJM, Strujik DG, de Blok K, Krediet RT
Differences in fluid transport between diabetic and non-
diabetic patients at the onset of CAPD
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S9 1997
The authors postulated that loss of transcapillary ultrafiltration (TCUF),
on CAPD may be caused by the high glucose concentration in the dialysate,
leading to glycation of water channels in the endothlial cells of
peritoneal microvessels. If such a hypothesis were true, the authors
hypothezised that then diabetics should
have lower TCUF at onset of PD (due to predialysis exposure of their PD
membranes to high glucose concentrations), but that the differences in TCUF
between diabetics and nondiabetics should disappear after
the non-diabetic patients had been exposed for several months to high
glucose concentrations.
They followed PD transport in 11 diabetics and 11 nondiabetics for one
year. No differences were found in solute transport between both groups at
the onset of CAPD, but, shortly after beginning CAPD, the TCUF rate was
lower in diabetics compared to nondiabetics as predicted. For the
authors, these findings suggest that long term exposure to high glucose
concentrations in diabetics prior to CAPD may cause changes in capillary
wall aquaporins similar to long term exposure to high glucose
concentrations in the dialysate in all CAPD patients.
Comment: This abstract is interesting as it seems to confirm the
role of glucose in aquaporin alterations on PD. However we are puzzled by
the fact that the authors suggest that exposure of the peritoneal capillary
wall to glucose would be comparable in non dialysed diabetics and normal
CAPD patients. The glucose concentration in the peritoneal cavity is
obviously much higher than the concentration which could be expected in the
worst diabetic patient : it is therefore difficult to make such a
comparison, as we are in quite different osmotic conditions. Alternatively,
from this study, we may suppose that only a slight increase in the ambient
glucose level, as observed in diabetics, may alter the structure of
aquaporin. One would then also expect to observe similar changes in non
diabetic CAPD who are permanently exposed to high glucose solutes.
(Christian Verger, M.D., Pontoise, France)
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17th Annual CAPD Conference
Basic peritoneal dialysis :
Physiology
CRF by problem area :
CRF and diabetes