Peritoneal dialysis is a relatively safe and effective form of
therapy for
acute renal failure (ARF). As
dextrose in the
dialysate provides the osmotic gradient to achieve fluid removal, frequent exchanges with
dialysate containing high
dextrose is occasionally used to achieve negative balance in fluid overloaded patients. It has previously been shown that
dextrose absorption from the peritoneal cavity is significant. Using indirect calorimetry and analyzing the
dialysate effluent for its
dextrose concentration, we studied the effects of high
dextrose-containing
dialysate in five patients with ARF. Despite minimal intake of calories, all patients had an RQ greater than 1.0 consistent with net lipogenesis resulting from
dextrose absorbed from the peritoneal cavity. Four of five patients absorbed greater than 500 g of
dextrose over 24 h. As overfeeding could lead to hepatic steatosis, increased CO2 production with worsening of
respiratory failure, and
hyperglycemia, the risks of using high
dextrose-containing
dialysate fluids should be weighed carefully against potential benefits. When
nutritional support is indicated in such patients, contribution of
dextrose calories from
dialysate fluid should be taken into account.