A physician is explaining the differences between hemodialysis and peritoneal dialysis to a 50-year-old patient with type 2 diabetes and end-stage renal disease. The patient is particularly concerned about metabolic control.
Compared to a patient on standard in-center hemodialysis, a patient on continuous ambulatory peritoneal dialysis is at a significantly higher risk for which of the following metabolic disturbances?
- Severe hyperkalemia
- Hyperglycemia and hypertriglyceridemia (correct answer)
- Refractory metabolic acidosis
- Hypocalcemia
Explanation: Peritoneal dialysis utilizes a dialysate solution containing high concentrations of dextrose to create an osmotic gradient for fluid removal (ultrafiltration). The continuous absorption of this glucose load across the peritoneal membrane can lead to significant hyperglycemia, weight gain, and hypertriglyceridemia. In contrast, hemodialysis is intermittent, and problems like hyperkalemia and metabolic acidosis are more likely to build up between sessions. Both modalities manage calcium and phosphate levels, but the glucose load is a unique and prominent feature of PD.