Introduction: The precise blood glucose (BG) profile of hemodialysis patients is unclear, as is the effectiveness of dipeptidyl peptidase-4 (DPP-4) inhibitors in hemodialysis patients with type 2 diabetes. Here, we used continuous glucose monitoring (CGM) to evaluate BG variability in these patients and to assess the efficacy of DPP-4 inhibitors, particularly during hemodialysis sessions and at nighttime (UMIN000012638). Methods: We examined BG profiles using CGM in 31 maintenance hemodialysis patients with type 2 diabetes. Differences between patients with and without DPP-4 inhibitors (n = 15 and 16, respectively) were analyzed using a linear mixed-effects model to assess changes in glucose levels in 5-min intervals. Results: The model revealed that DPP-4 inhibitor use was significantly associated with suppression of a rapid drop in glucose levels, both with and without adjustment for BG levels at the start of hemodialysis. Moreover, the model revealed that the two groups differed significantly in the pattern of changes in BG levels from 0:00 to 6:55 am. DPP-4 inhibitors Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare. 12937694.
Background: The benefits of dietary protein restriction in chronic kidney disease (CKD) remain unclear, largely due to inadequate adherence in most clinical trials. We examined whether low-protein rice (LPR), previously developed to reduce the protein content of rice, as a major staple food, would help improve adherence to dietary protein restriction. Methods: This open-label multicenter randomized controlled trial evaluated the efficacy of LPR use for reducing dietary protein intake (DPI) in patients with CKD stages G3aA2 to G4. Participants were randomly assigned in a 1:1 ratio to an LPR or control group and were followed up for 24 weeks. Both groups received regular counseling by dietitians to help achieve a target DPI of 0.7 g/kg ideal body weight (IBW)/day. The amount of protein in LPR is about 4% of that in ordinary rice, and the participants in the LPR group were instructed to consume LPR with at least two meals/day. The primary outcome was estimated DPI (eDPI) determined using Maroni's formula. The secondary outcomes included creatinine clearance (CCr) and urinary protein based on 24-h urine collection. Results: In total, 51 patients were randomized either to the LPR group or control group. At baseline, mean age was 62.5 years, 70% were men, mean CCr was 52.0 mL/min, and mean eDPI was 0.99 g/kg IBW/day. At 24 weeks, mean eDPI decreased to 0.80 g/kg IBW/day in the LPR group and to 0.91 g/kg IBW/day in the control group, giving a between-group difference of 0.11 (95% confidence interval, 0.03-0.19) g/kg IBW/day (P=0.006). There was no significant between-group difference in CCr, but urinary protein was lower at 24 weeks in the LPR group than in the control group. Conclusions: LPR is a feasible tool for efficiently reducing DPI in CKD patients.
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