Does diabetes mellitus predispose to increased fluid overload in peritoneal dialysis patients?

BACKGROUND

Diabetic peritoneal dialysis patients have been reported to have faster peritoneal solute transport and may be at risk of reduced ultrafiltration volumes, leading to fluid overload.

METHODS

We audited multi-frequency bioimpedance data from 198 consecutive peritoneal dialysis patients (141 nondiabetics and 57 diabetics).

RESULTS

Diabetic patients had increased body mass index (males 27 +/- 4 vs. 26 +/- 4; females 28 +/- 5 vs. 25 +/- 4; p < 0.01 for both), waist to hip ratio (males 0.94 +/- 0.07 vs. 0.94 +/- 0.04; females 0.99 +/- 0.9 vs. 0.94 +/- 0.09; p < 0.01 for both) and body fat (males 31 +/- 8 vs. 26 +/- 11%, p < 0.05; females 40 +/- 8 vs. 33 +/- 10%, p < 0.01) compared to nondiabetic patients. D4/P creatinine was greater for the female diabetic patients than the nondiabetic patients (0.75 +/- 0.1 vs. 0.69 +/- 0.1; p = 0.044); otherwise, the peritoneal equilibrium test (PET) results did not differ. Extracellular water (ECW) adjusted for height was similar in diabetic and nondiabetic patients, but the ratio of ECW to total body water (TBW) was greater for diabetics (males 0.40 +/- 0.01 vs. 0.39 +/- 0.01; females 0.39 +/- 0.01 vs. 0.38 +/- 0.01; p < 0.05 for both).

CONCLUSIONS

Diabetic and nondiabetic patients had similar PET results, 24-hour net peritoneal ultrafiltration and blood pressure control. The ratio of ECW to TBW was greater in diabetic patients, and although this could be due to a loss of intracellular water, as albumin and C-reactive protein did not differ, it suggests that diabetic peritoneal dialysis patients have an expanded extracellular volume.