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 p p 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.背景：近期研究表明，肾衰竭合并糖尿病患者在启动腹膜透析（peritoneal dialysis, PD）后的90天内，发生透析技术失败及转为血液透析的风险显著升高。本研究旨在探究起始PD治疗的前3个月内，糖尿病与非糖尿病患者之间是否存在临床差异。方法：本研究回顾分析了择期启动PD治疗、且在治疗后6~10周接受对应生物阻抗（bioimpedance）检测及首次腹膜平衡试验（peritoneal equilibrium test, PET）的连续入组患者的相关数据。结果：本研究共纳入386例成年患者，其中男性230例（59.6%），糖尿病患者152例（39.4%），白人188例（48.7%），平均年龄为57.3±16.9岁。尽管两组患者的体重、残余肾功能及腹膜清除率无显著差异，但糖尿病患者的细胞外水与总体水比值（extracellular water to total body water, ECW/TBW；40.4±1.1 vs. 39.2±1.4）及细胞外水过剩百分比[9.6（6.3~12.3）vs. 4.9（0.7~8.9）]均更高，血清白蛋白水平更低（35.2±4.7 vs. 37.8±4.9 g/L），脂肪质量指数更高（9.5±4.2 vs. 7.7±4.2）；虽然两组平均动脉压相近，但糖尿病患者的动脉脉压更高（66.9±10.8 vs. 54.3±17.3 mm Hg，除脉压p=0.012外其余指标均p<0.05），且ECW/TBW与血清白蛋白（β=-0.14，p=0.033）及肌酐（β=-0.18，p=0.02）呈负相关。结论：与非糖尿病患者相比，择期启动PD治疗的糖尿病患者在治疗后6~10周时的ECW/TBW比值及细胞外水过剩情况更为显著，尽管两组的PET结果无明显差异。细胞外水增多可能使糖尿病患者面临更高的容量超负荷风险。