Adsorption of insulin to the surface of peritoneal dialysis solution containers

Continuous ambulatory peritoneal dialysis (CAPD) is becoming widely used in diabetics with end-stage renal disease. One of the proposed advantages of this technique is the ability to administer insulin intraperitoneally. The administration of insulin by this route provides acceptable plasma glucose control with no need for subcutaneous injections. Because adsorption of insulin to glass and polyvinyl chloride (PVC) surfaces is known to occur with intravenous fluid systems, this study was conducted to measure insulin adsorption to dialysis fluid systems. The effects of time, temperature, heparin concentration, dextrose concentration, and insulin concentration in 2-L glass and PVC dialysis solution containers were studied. While all factors significantly affected adsorption to the PVC containers, the effects of heparin and dextrose were considered to be clinically unimportant. The percentage of insulin adsorbed to the PVC surface increased with increasing time and temperature and decreased with increasing insulin concentrations. Under the conditions studied, 7.1% to 9.6% of insulin added to PVC containers was lost within the first minute. Since 15 to 30 minutes is required by most CAPD patients to prepare and instill the dialysate, 10% to 20% of added insulin may be adsorbed to the PVC bad. The adsorption of insulin to the glass surfaces was rapid with 39.6% to 42.8% being lost within the first minute. All factors studied significantly affected adsorption to the glass, but the effects of time, temperature, dextrose, and heparin were considered to be of minor clinical importance.(ABSTRACT TRUNCATED AT 250 WORDS)