Kidney Week

Abstract: FR-PO1103

Reducing Hypertonic Glucose Exposure in Peritoneal Dialysis Through Structured Prescription Optimization

Session Information

• Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Fawzy, Ashraf, Hamad Medical Corporation, Doha, Alryan, Qatar

Ashraf Fawzy, MBBS

• Fouda, Tarek Ahmed Elsayed, Hamad Medical Corporation, Doha, Alryan, Qatar

Tarek Ahmed Elsayed Fouda, MD

• Ahmed, Hanaa, Hamad Medical Corporation, Doha, Alryan, Qatar

Hanaa Ahmed, RN

• Alabdulla, Thoraya Alfahad, Hamad Medical Corporation, Doha, Alryan, Qatar

Thoraya Alfahad Alabdulla, RN

• Vergel, Merlina, Hamad Medical Corporation, Doha, Alryan, Qatar

Merlina Vergel, RN

• Chacko, Linu chacko, Hamad Medical Corporation, Doha, Alryan, Qatar

Linu chacko Chacko, RN

• Ali, Ahlam, Hamad Medical Corporation, Doha, Alryan, Qatar

Ahlam Ali

• Ali, Nahid Ibrahim, Hamad Medical Corporation, Doha, Alryan, Qatar

Nahid Ibrahim Ali

• Akl, Tabasim Ali, Hamad Medical Corporation, Doha, Alryan, Qatar

Tabasim Ali Akl, RN

• Ghanoum, Ammar, Hamad Medical Corporation, Doha, Alryan, Qatar

Ammar Ghanoum, RN

• Arroub, Hasan Mahmoud, Hamad Medical Corporation, Doha, Alryan, Qatar

Hasan Mahmoud Arroub

• Alqahtani, Heba Abdulla, Hamad Medical Corporation, Doha, Alryan, Qatar

Heba Abdulla Alqahtani, RD

• Alkadi, Mohamad M., Hamad Medical Corporation, Doha, Alryan, Qatar

Mohamad M. Alkadi, MD

• Hamad, Abdullah Ibrahim, Hamad Medical Corporation, Doha, Alryan, Qatar

Abdullah Ibrahim Hamad, MD, FASN

• Al-Malki, Hassan A., Hamad Medical Corporation, Doha, Alryan, Qatar

Hassan A. Al-Malki, MD

Background

Long-term hypertonic glucose exposure in peritoneal dialysis (PD) is associated with metabolic complications and peritoneal membrane injury. We studied a structured strategy to reduce avoidable 2.27% dextrose exposure while preserving volume control and dialysis adequacy.

Methods

Of 184 PD patients screened, 25 met eligibility criteria for potentially avoidable 2.27% dialysate use, defined as ongoing hypertonic exposure despite acceptable ultrafiltration (>1.5 L/day), volume status, and dialysis adequacy. The intervention included individualized prescription review, stepwise substitution of 1.36% for 2.27% dialysate when appropriate, reinforcement of sodium/fluid restriction, and follow-up calls. Primary outcomes were changes in 2.27% and 1.36% dialysate utilization. Secondary outcomes included ultrafiltration, peritoneal Kt/V, body weight, HbA1c, albumin, and blood pressure.

Results

Mean 2.27% dialysate volume decreased from 5.37 ± 3.49 to 3.26 ± 2.94 L/day (p<0.001), while 1.36% use increased from 0.64 ± 1.25 to 2.50 ± 1.40 L/day (p<0.001) (Figure 1). Among 25 patients, 20/25 (80%) achieved ≥25% reduction in 2.27% exposure, of whom 13/25 (52%) achieved ≥50% reduction. Patients not reaching the 25% threshold had high baseline prescriptions (>8 L/day) with meaningful absolute reductions.
Ultrafiltration remained stable [1.40 (0.9–2.0) vs 1.60 (1.0–2.2) L; p=0.26], and peritoneal Kt/V did not decline (1.69 ± 0.38 vs 1.81 ± 0.43; p=0.124). HbA1c improved from 6.25 ± 1.30% to 5.58 ± 0.69% (p=0.001), serum albumin increased from 29.36 ± 3.73 to 31.12 ± 4.15 g/L (p=0.010), and body weight/BMI decreased

Conclusion

Structured PD prescription optimization reduced hypertonic glucose exposure without compromising ultrafiltration, dialysis adequacy, or blood pressure control and was associated with favorable metabolic and nutritional changes. These findings support individualized glucose-sparing PD strategies in selected patients.