# Impact of Incremental Peritoneal Dialysis on Cardiometabolic Parameters

## TL;DR

This study found that incremental peritoneal dialysis reduces glucose exposure and serum glucose levels compared to full-dose dialysis, but had no significant long-term impact on cardiometabolic trends.

## Contribution

The study provides new evidence on the glucose-related benefits of incremental peritoneal dialysis and its limited effect on broader cardiometabolic outcomes.

## Key findings

- Incremental PD was associated with significantly lower cumulative glucose exposure and higher serum glucose levels compared to full-dose PD.
- No significant differences were observed in trends for BMI, dry weight, cholesterol, or HbA1c between the two groups.
- The study highlights the potential of incremental PD to reduce glucose-related cardiometabolic burden but shows no long-term improvement in cardiometabolic parameters.

## Abstract

Background

Glucose is the predominant osmotic agent of peritoneal dialysis (PD) fluid. The systemic exposure to glucose experienced by people receiving PD has been linked to insulin resistance and cardiovascular morbidity. Incremental PD has been associated with a lower exposure to glucose, but little is known about the impact on measures of insulin resistance. We hypothesised that patients on incremental PD would have a lower glucose-related cardiometabolic burden. This study aimed to compare trends in cardiometabolic parameters, including serum glucose, haemoglobin A1c (HbA1c), cholesterol, body mass index (BMI), and body weight, between patients receiving incremental and full-dose peritoneal dialysis.

Materials and methods

This was a retrospective study with a two-year follow-up period. Adults who had received PD between 2015 and 2022 were included. The eligibility criteria included a minimum PD duration of 12 months and a 24-hour urine volume of at least 500 mL at the onset of PD. Demographic and clinical data, including PD prescriptions, were collated. Cardiometabolic parameters, including dry weight, BMI, HbA1c, cholesterol and serum glucose levels, were collected as outcome measures at six-monthly intervals.

Eligible participants were categorised into incremental PD and full-dose PD groups based on prespecified criteria. The PD prescriptions were used to estimate cumulative peritoneal glucose exposure. Generalised linear mixed methods analysis was used to evaluate the effect of incremental PD on the trend in outcome measures.

Results

A total of 117 (incremental = 46; full dose = 71) patients were included in the study. There was no significant difference in baseline demographic or clinical parameters, except for HbA1c, which was lower in the incremental cohort (5.3 [5.2 to 6.6]) compared to the full dose cohort (6.6 [6.0 to 7.5], p = 0.04). The estimated cumulative glucose exposure was substantially lower in the incremental cohort (65kg at 24 months) compared to the full-dose group (105kg at 24 months, p < 0.001). After adjusting baseline characteristics, higher serum glucose was associated with full-dose PD compared to incremental PD (coefficient = 0.17 [0.00 to 0.35], p = 0.05), although there was no difference in the trend over time. There was also no significant difference in trends for BMI, dry weight, cholesterol or HbA1c.

Conclusion

In this retrospective cohort study, cumulative dialysate glucose exposure and serum glucose levels were significantly lower with incremental PD compared to full-dose PD. However, there was no significant difference in cardiometabolic trends over time. Prospective studies will help establish the potential benefits of incremental therapies on cardiometabolic parameters and cardiovascular risk in PD patients.