Effect of diabetes and peritonitis on the peritoneal equilibration test

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 patients on CAPD (1 to 3 months) with no history of peritonitis, diabetics had higher D/PCr than non-diabetics (P < 0.02). However, after ≥7 months of CAPD, in patients with ≤2 episodes of peritonitis, glucose and creatinine transport rates were lower (P < 0.05) in diabetic than non-diabetic patients. Among patients on CAPD for ≥7 months, creatinine (P < 0.05) and glucose transport (P < 0.01) were higher in patients with a history of ≥3 episodes of peritonitis than in those with ≤2 episodes. Drain volumes did not differ between any of the subgroups (all P > 0.05). The observations in patients newly established on CAPD were substantiated in a larger study of 55 non-diabetic and 35 non-insulin dependent diabetic patients. D/D0 glucose correlated with plasma glucose (r = 0.40, P < 0.02) in the diabetic group. Net ultrafiltration was reduced in hyperglycemic (P = 0.022) but not normoglycemic diabetics (non-diabetics 231 ± 167 ml, hyperglycemic diabetics 127 ± 177 ml, normoglycemic diabetics 238 ± 159 ml). Creatinine clearance was higher in normoglycemic (P = 0.02) but not hyperglycemic diabetics (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 data show that diabetes and peritonitis incidence should be borne in mind when interpreting results of the PET. We conclude that peritoneal membrane transport differs in non-insulin dependent diabetic patients and that ultrafiltration will be lower than is achievable in non-diabetic patients with the same glucose transport rate unless normoglycemia is maintained.