High Peritoneal Permeability Predisposes to Hepatic Steatosis in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients Receiving Intraperitoneal Insulin

Abstract

Objective

To evaluate hepatic fat accumulation in diabetic patients taking intraperitoneal or subcutaneous insulin treatment during continuous ambulatory peritoneal dialysis (CAPD).

Design

Cross-sectional study.

Setting

Tertiary-care university hospital.

Patients

We studied 16 patients with diabetic end-stage renal disease currently treated with CAPD. Median age was 42 years (range: 34 – 70 years), duration of diabetes was 27.5 years (range: 17 – 39 years), and duration of CAPD was 16.5 months (range: 2 – 59 months).

Outcome Measures

Ultrasound measures of liver steatotic area and thickness, peritoneal equilibration test (PET), weekly Kt/V urea, protein catabolic rate (PCR), hemoglobin A1c (HbA1c), lipoproteins, alanine aminotransferase, alkaline phosphatase, insulin dose, and dialysate glucose load.

Results

Focal hepatic fat accumulation was found. The location of steatosis was subcapsular; a negligible amount was periportal. Hepatic subcapsular steatosis was present in 7 of 8 patients taking insulin intraperitoneally and in 0 of 8 patients taking insulin subcutaneously. The maximal thickness of subcapsular steatosis correlated directly with peritoneal transport rate (2-hour dialysate-to-plasma creatinine ratio in PET, r = 0.80, p < 0.05) and inversely with PCR (r = –0.82, p < 0.05). The area of the lesions correlated directly with body weight (r = 0.80, p < 0.05) and inversely with weekly Kt/V urea (r = –0.90, p < 0.01).

Conclusions

Intraperitoneal insulin, together with glucose-based peritoneal dialysate, induces hepatic subcapsular steatosis. The amount of hepatic subcapsular steatosis increases when peritoneal transfer rate and body weight are high.