Supplementary Material for: Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

Background: Recent reports have highlighted that
diabetic patients with kidney failure are at increased risk of technique
failure and transfer to haemodialysis within 90 days of initiating
peritoneal dialysis (PD). We wished to determine whether there were
differences between diabetic and non-diabetic patients within the first 3
months of starting PD. Methods: We reviewed results of
corresponding bioimpedance and the 1st test of peritoneal membrane
function (PET) in consecutive patients, 6-10 weeks after initiating PD
electively. Results: Adult patients numbering 386 - 230
males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3
±16.9 years - were studied. Although weight, residual renal function and
peritoneal clearances were not different, diabetic patients had greater
extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ±
1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum
albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ±
4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was
similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ±
17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion:
Diabetic patients electively starting PD were found to have greater
ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to
non-diabetics, despite similar PET. Increased ECW could predispose
diabetic patients to be at greater risk of volume overload.