Hypoproteinemia in patients with diabetes undergoing continuous ambulatory peritoneal dialysis is attributable to high permeability of peritoneal membrane

Background. The present study used the newly developed personal dialysis capacity (PDC) peritoneal function test to investigate differences in individual peritoneal membrane transport function and nutritional status in non diabetic (non DM) and diabetic (DM) patients on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods:To clarify the differences in perk toneal function that determine plasma protein levels, we carried out PDC tests in non DM and DM patients. Between May 1995 and May 1999, in multicenter study in Japan, we carried out 232 PDC tests on 232 non DM patients and 47 PDC tests on 47 DM patients who had been on CAPD for 1 - 210 months. Results: Plasma levels of total protein and albumin in DM patients were significantly lower than those in non DM patients (total protein: 6.5 +/- 0.1 g/dL non DM vs. 5.9 +/- 0.1 g/dL DM, p < 0.0001; albumin: 3.5 +/- 0.1 g/dL non DM vs. 2.9 +/- 0.1 g/dL DM, p < 0.0001). The mean membrane area in the DM group was significantly larger than that in the non DM group (21 943 +/- 608 cm/1.73 m(2) non DM vs. 26 304 +/- 1699 cm/1.73 m(2) DM, p = 0.0076). The mean plasma loss through the large pores in the DM group was significantly greater than that in the non DM group (0.095 +/- 0.004 mL/min/1.73 m(2) non DM vs. 0.119 +/- 0.008 mL/min/1.73 m(2) DM, p = 0.0113). Protein loss into dialysate in DM patients was significantly greater than that in non DM patients. We observed a significant correlation between total protein or albumin and plasma loss from dialysis solution in non DM and DM patients on CAPD. Conclusions:The study demonstrated that peritoneal function, including peritoneal membrane transport and peritoneal permeability to protein was significantly higher in DM patients than in non DM patients. Hypoproteinemia in DM patients might be associated with high permeability of peritoneal membrane in CAPD.