Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials
Journal of clinical lipidology
Diabetes; Lipid metabolism; Lipoproteins; Low glucose dialysis; Peritoneal dialysis
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.
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