Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials

►Peritoneal dialysis (PD) uses glucose, which may contribute to atherogenic dyslipoproteinemia.►Patients with diabetes were treated on a low glucose or standard (dextrose) PD regimen for 6 months.►Lipid and apolipoprotein serum levels were analyzed at baseline, 3 months, and 6 months.►Lipid and apolipoprotein levels decreased in low-glucose PD, but increased in standard PD treatment.►Low-glucose PD improved atherogenic lipoprotein phenotype compared with standard PD.

BackgroundGlucose, the conventional osmotic agent in peritoneal dialysis (PD) solutions, may contribute to atherogenic dyslipoproteinemia and increased cardiovascular risk.ObjectiveTo determine whether a low-glucose PD regimen may improve the serum lipid and lipoprotein profile in patients with diabetes.MethodsA prospective, open-label, parallel group, multinational, randomized, controlled trial with a 6-month follow-up, comprising 251 patients with diabetes receiving PD. Patients were randomized to a low-glucose PD regimen (dextrose-based PD solution plus icodextrin, a starch polymer, and amino acids) or a conventional PD regimen (dextrose PD solutions). Serum lipid and apolipoprotein profiles were determined at baseline and 3 and 6 months.ResultsSerum triglycerides, very low-density-lipoprotein cholesterol, and apolipoprotein B (apoB) decreased significantly in the intervention group at both 3 and 6 months compared with baseline (serum triglycerides: median change at 3 months −0.5 mmol/L, P < .001, at 6 months −0.3 mmol/L, P < .001; very low-density-lipoprotein cholesterol: −0.3 mg/dL, P < .001; −0.3 mg/dL, P < .001; and apoB: −8.5 mg/dL, P < .001; −3.6 mg/dL, P = .043, respectively) and also compared with the control group. In contrast, apoB levels increased significantly in the control group at 3 and 6 months compared with baseline (5.3 mg/dL, P = .041; 5.2 mg/dL, P = .007, respectively). Percentage of patients on lipid-lowering medications at baseline and intensity of therapy was equivalent in each group. The apoB decrease was not affected by lipid-lowering medications in the intervention group.ConclusionA low glucose-PD regimen significantly improved the atherogenic lipoprotein phenotype compared with PD patients treated with a conventional glucose regimen.