IntraperitonealInsulin: A Protocol for Administration during CAPD and Review of Published Protocols

For many diabetics in end-stage renal failure, the initial therapy they receive will be continuous ambulatory peritoneal dialysis (CAPD) together with i.p. insulin. To date, all published protocols rely on empirical dosages based upon predialysis insulin requirements. A practical regimen for the institution of i.p. insulin administration during CAPD is described. The only endpoints used to determine insulin dosage were fasting plasma glucose 5 to 10 mmol/L and 2 h postprandial plasma glucose 8 to 15 mmol/L. An initial protocol related to body weight, dextrose content, volume, and timing of dialysate was based on a retrospective analysis of the results in our first 10 patients. Subsequently, a prospective assessment in an additional 22 patients confirmed the effectiveness of the regimen. The following protocol is recommended for the institution of i.p. insulin therapy in patients undergoing CAPD: Preprandial exchanges 1.36% dextrose-0.175 U/L dialysate/kg body weight 3.86% dextrose-0.25 U/L/kg Overnight exchanges 1.36% dextrose-0.1 U/L/kg 3.86% dextrose-0.15 U/L/kg Further adjustment of insulin dosage is then made on the basis of four hourly plasma glucose profiles. Self-monitoring of capillary blood glucose is recommended.

Increased Salivary Concentration of Human Epidermal Growth Factor in Patients Undergoing CAPD

Epidermal growth factor (EGF) was measurea In the saliva of 36 patients with chronic renal failure (CRF) and 29 matched control subjects. Salivary EGF in controls was 0.65±0.009 nmol/L compared with 0.99±0.24 nmol/L in nondialyzed CRF patients, 1.15±0.23 in hemodialyzed patients and 1.96±0.25 (p < 0.01, Wilcoxon Rank Sum Test) in CAPO-treated patients. On Sephadex chromatography, the major peak of immunoreactive EGF from patient and control saliva samples coeluted with purified human EGF. We conclude that salivary concentrations of human EGF are significantly elevated in end-stage renal failure, particularly in patients treated by CAPO.

Glucose tolerance in patients undergoing continuous ambulatory peritoneal dialysis

The effects of continuous ambulatory peritoneal dialysis (CAPD) on glucose tolerance and serum immunoreactive insulin and glucagon responses to oral glucose over the first year of therapy were studied in 13 uremic patients. Oral glucose tolerance tests were performed before treatment started, and again after 3 and 12 months on CAPD. Before CAPD, the patients showed decreased glucose tolerance. However, neither fasting blood glucose and serum insulin and glucagon levels nor the insulin and glucagon levels during the tests were significantly different from results obtained in 13 healthy controls. During CAPD, the mean intraperitoneal supply of glucose from the dialysates varied between 121 and 245 g/day and did not change during the study period. Glucose tolerance and hormone responses to glucose did not change during the study period. No patient developed manifest diabetes mellitus. We conclude that glucose intolerance in uremia persists during CAPD, but despite the continuous peritoneal absorption of 100-200 g of glucose during CAPD, the treatment had no effect on glucose tolerance and insulin secretory response.