Adverse effects of systemic glucose absorption with peritoneal dialysis: how good is the evidence?

Treatment of end-stage renal disease with peritoneal dialysis is associated with an obligatory absorption of carbohydrates with both glucose and icodextrin-based dialysate. In this review, we examine the evidence linking this obligatory absorption with adverse systemic effects.

Systemic glucose absorption is associated with worse glycemic control; this can be ameliorated with glucose-sparing peritoneal dialysis regimens. The studies examining the benefit of glucose-sparing regimens on dyslipidemia are inconsistent and the magnitude of benefit is potentially small. There are no studies demonstrating any improvement in clinically meaningful patient outcomes with glucose-sparing regimens.

Although it is conceivable that the obligatory carbohydrate absorption with peritoneal dialysis increases systemic cardiovascular risk, this premise has not been systematically or rigorously examined to date, there are no robust biomarkers to measure the risk, modification of which may favorably improve outcomes, and whether glucose-sparing peritoneal dialysis regimens will lower the putative risk is currently unknown. Hence, there is a compelling need to bridge our gap in understanding the role of systemic glucose absorption with peritoneal dialysis on the health of individuals undergoing peritoneal dialysis.