This document summarizes some of the metabolic complications that can occur with peritoneal dialysis (PD). It notes that while PD is generally well-tolerated, it can lead to issues like glucose absorption, protein loss, and lipid abnormalities. Glucose is used as the osmotic agent in PD fluid and is readily absorbed, which can cause hyperinsulinemia and hypertriglyceridemia in patients. Protein is also lost across the peritoneum in PD. Electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, and hypermagnesemia can arise depending on the composition of the dialysate fluid and

1. Metabolic Complication of
Peritoneal dialysis
Yousaf khan
Renal Dialysis Lecturer
IPMS-KMU

2. Introduction
 PD is generally well tolerated and serves as an effective form of
RRT.
 PD a number of metabolic abnormalities
Glucose absorption:
Advantage:
 Stander agent added to PD fluid as an osmotic agent ( Amino
acid and polyglucose solution alternative )
 Advantage of glucose cheap, stable and relatively non toxic to
the peritoneum
 Easily absorbed across the membrane (60-80% ) with each
CAPD exchange
 APD cycles tend to be shorter than CAPD
 Glucose loading from PD may contribute to further weight gain.

3. Glucose absorption:
Disadvantage:
 Increased Insulin secretion – as result plasma insulin levels that
are persistently high.
 Hyperinsulinemia risk factor the atherosclerosis
 Some patient initiation of oral hypoglycemics or insulin therapy
 Hypertrigyceridemia found in PD patients.
Protein loss:
 Significant loss of protein across the peritoneum
 Loss is about 0.5 g/L of dialysate drainage but may be higher.
 Major component of the protein losses is albumin.
 PD patient have lower serum albumin level than their HD.

4. Lipid abnormalities
Factor PD HD
Total Cholesterol Increase Normal
LDL cholesterol Increase Normal
HDL cholesterol Decrease Decrease
Triglycerides Increase Increase
Apo A1 protein Decrease Decrease
Apo B protein Increase Normal
Lp (a) Increase Increase
LDL oxidation Increase Increase

5. Hyponatremia / Hypernatremia:
 PD solutions typically contain 132 mM of sodium
 Most patients maintain a normal serum sodium on PD.
Hyponatremia:
 Excessive water drinkers can get a dilutional hyponatremia
 In patient with marked hyperglycemia, translocational hyponatremia
may be seen as a result of water shifting into the extra cellular fluid .
 Serum sodium falls rise in blood glucose.
Hypernatremia:
 With rapid ultrafiltration using hypertonic solutions, hypernatremai
may occur due to sieving effect of the peritoneal membrane on
sodium

6. Hypokalemia / Hyperkalemia
 Stander PD solution contains no potassium.
 Potassium is removed during PD by diffusion and convection.
 Hyperkalemia generally results from excessive dietary intake and
insufficient dialysis.
 Hypokalemia is due to poor nutritional intake; excessive losses,
either through vomiting or diarrhea or excessive dialysate losses.
Hypocalemia/ Hypercalcemia:
 PD solution are abailable with 1.25 mM (2.5 mEq/L) or 1.75 mM
(3.5mEq/L).
Hypermagnesemia:
 Hypermagnesemia is a common finding in CAPD patients
particularly among those ingesting magnesium containing phosphate
binders, antacids or laxatives.
 Hypermagnesemia suppresses PTH levels contributing to adynamic
bone disease

7. Thank You