Assessment of Glycemic Profiles Using Continuous Glucose Monitoring in Patients with ESKD Treated with Automated Peritoneal Dialysis

Background: The patients using automated peritoneal dialysis (APD) faced unphysiological glucose loading during nighttime, which caused difficulty in glycemic control. Data on glucose dynamics in patients using APD was still limited. This study aimed to evaluate 24-hour glycemic profiles in APD patients by continuous glucose monitoring (CGM) Methods: In this cross-sectional study, 30 APD patients were enrolled, including 10 diabetes (DM) with insulin used, 10 DM without insulin used, and 10 non-DM. All participants underwent seven days of CGM. The primary outcome was the glycemic profiles demonstrated by mean and under the curve (AUC) of interstitial glucose concentrations and the mean amplitude of glycemic excursions (MAGE). Data analysis encompassed the whole 7-day period and compared daytime and nighttime Results: There were no significant differences in the mean glucose, AUC, and MAGE between the APD and non-APD periods in all groups. The mean difference in glucose during daytime and nighttime was comparable between DM with insulin and non-DM group (p= 0.364). During the APD period, the mean glucose, MAGE, and AUC were significantly higher in DM patients with insulin compared to non-DM patients (p ≤ 0.05). Dialysate glucose exposure did not influence the disparity in mean glucose concentration and AUC during the APD period in both DM (p=0.508) and non-DM groups (p =1.00). From multivariate analysis, only DM with insulin-used status was associated with mean glucose concentration (coefficient 97.84, p =0.03), while membrane transport status and glucose concentration in dialysate showed no association Conclusion: ESKD patients using APD demonstrated comparable glycemic profiles during the APD and non-APD period with unphysiological non-glucose dipping during nighttime among all DM statuses Funding: Government Support – Non-U.S.Mean glucose during APD and non-APD periods in each group