Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials

Authors

Allan D. Sniderman, McGill University Health Centre, McGill University, Montreal, Canada. Electronic address: allansniderman@hotmail.com.
James A. Sloand, Baxter Healthcare Corporation, Deerfield, IL, USA.
Philip K. Li, Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
Ken Story, Baxter Healthcare Corporation, Deerfield, IL, USA.
Joanne M. Bargman, University Health Network and University of Toronto, Toronto, Canada.

Document Type

Journal Article

Publication Date

7-1-2014

Journal

Journal of clinical lipidology

Volume

8

Issue

4

DOI

10.1016/j.jacl.2014.03.007

Keywords

Diabetes; Lipid metabolism; Lipoproteins; Low glucose dialysis; Peritoneal dialysis

Abstract

BACKGROUND: Glucose, the conventional osmotic agent in peritoneal dialysis (PD) solutions, may contribute to atherogenic dyslipoproteinemia and increased cardiovascular risk. OBJECTIVE: To determine whether a low-glucose PD regimen may improve the serum lipid and lipoprotein profile in patients with diabetes. METHODS: A prospective, open-label, parallel group, multinational, randomized, controlled trial with a 6-month follow-up, comprising 251 patients with diabetes receiving PD. Patients were randomized to a low-glucose PD regimen (dextrose-based PD solution plus icodextrin, a starch polymer, and amino acids) or a conventional PD regimen (dextrose PD solutions). Serum lipid and apolipoprotein profiles were determined at baseline and 3 and 6 months. RESULTS: Serum triglycerides, very low-density-lipoprotein cholesterol, and apolipoprotein B (apoB) decreased significantly in the intervention group at both 3 and 6 months compared with baseline (serum triglycerides: median change at 3 months -0.5 mmol/L, P < .001, at 6 months -0.3 mmol/L, P < .001; very low-density-lipoprotein cholesterol: -0.3 mg/dL, P < .001; -0.3 mg/dL, P < .001; and apoB: -8.5 mg/dL, P < .001; -3.6 mg/dL, P = .043, respectively) and also compared with the control group. In contrast, apoB levels increased significantly in the control group at 3 and 6 months compared with baseline (5.3 mg/dL, P = .041; 5.2 mg/dL, P = .007, respectively). Percentage of patients on lipid-lowering medications at baseline and intensity of therapy was equivalent in each group. The apoB decrease was not affected by lipid-lowering medications in the intervention group. CONCLUSION: A low glucose-PD regimen significantly improved the atherogenic lipoprotein phenotype compared with PD patients treated with a conventional glucose regimen.

APA Citation

Sniderman, A. D., Sloand, J. A., Li, P. K., Story, K., & Bargman, J. M. (2014). Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials. Journal of clinical lipidology, 8 (4). http://dx.doi.org/10.1016/j.jacl.2014.03.007