The Impact of Intraperitoneal Glucose and Insulin on the Liver

Abstract

In patients on peritoneal dialysis, the infusion of dialysate leads to continuous exposure of the liver to high levels of glucose. Furthermore, many dialysis patients with diabetes mellitus add insulin to the dialysate. In this case, the liver is in simultaneous contact with both insulin and glucose, which can have interacting effects on hepatic metabolism.

In this review the rationale of intraperitoneal insulin for glycemic control will be discussed, and what evidence there is that glucose and insulin enter the liver from dialysate. This will lead to a brief review of the pathogenesis of hepatic steatosis and finally to a description of the unique steatosis found only in peritoneal dialysis patients who use intraperitoneal insulin.