Objective This pilot study aimed to preliminarily investigate the short‐term effects of a combination regimen of acarbose combined with standard glucose dialysate on residual renal function and microinflammatory status in patients newly initiated on peritoneal dialysis and to preliminarily analyze the mediating role of volume load and microinflammatory status in these outcomes. Method A randomized controlled design was employed, with 128 patients newly initiating peritoneal dialysis randomly assigned in a 1:1 ratio. Ultimately, 110 patients completed full follow‐up and were included in the analysis (55 patients in each of the experimental and control groups). The mean age of patients was approximately 54.5 years, with males accounting for 55.5%. At the conclusion of follow‐up, both groups comprised 55 patients each. The experimental group received treatment with “1.5% glucose solution during the day + 7.5% acarbose solution at night,” while the control group received standard glucose dialysate throughout the entire study period. The intervention period lasted 24 weeks. The primary outcome measure was residual renal Kt/V at 6 months (T2). Primary outcomes were compared using covariance analysis, and mediation effects were evaluated. The mediating roles of volume load (ΔECW/TBW) and microinflammation status (Δhs‐CRP) at 3 months postintervention (T1) were evaluated. Results After 6 months of intervention, patients in the experimental group demonstrated significantly higher residual kidney Kt/V at T2 compared to the control group (0.62 ± 0.14 vs. 0.54 ± 0.16, p = 0.012), and their estimated glomerular filtration rate (eGFR) was also significantly superior to that of the control group ( p < 0.001). Concurrently, the experimental group demonstrated improved microinflammation status (hs‐CRP at T2: 3.70 vs. 5.70 mg/L, p < 0.001), with volume load controlled (ECW/TBW at T2: 0.394 vs. 0.402, p < 0.001), and nutritional status enhanced (serum albumin at T2: 38.80 vs. 35.80 g/L, p < 0.001). Mediation analysis indicated that treatment grouping significantly improved volume load and microinflammation status at T1 (pathway a significant, p < 0.01). However, neither of these factors significantly predicted residual renal function changes at T2 (pathway b not significant), and the indirect effect failed to reach statistical significance. Conclusion For patients initiating peritoneal dialysis, the 6‐month acarbose combination regimen demonstrated superior short‐term effects compared to the standard glucose regimen in delaying residual renal function decline, alleviating microinflammatory states, and improving volume load. The protective effects, however, may not primarily result from volume load improvement and microinflammatory reduction.
Song et al. (Thu,) studied this question.