Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia

Abstract

Objective: To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. Subjects and methods: Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. Results: Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 -t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. Conclusions: The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control. Arch Endocrinol Metab. 2015;59(2):137-40

Risk of falls in chronic kidney disease

“…Equally important is the special type of hypoglycemia that occurs in HD sessions affecting more often diabetic HD patients. This is the intradialytic hypoglycemia, which affects more often the diabetic renal patients, especially those who have achieved a better glycemic control 25 .…”

Glucose Levels During Dialysis with Glucose-Free Versus Glucose-Rich Dialysate Fluid

“…Jackson and co-workers showed dialysis patients with an initial plasma glucose of 5.5 mmol/l (100 mg/dl) or less who did not eat during dialysis may be particularly at risk, especially, those on insulin or glucose-lowering medications [1]. Based on studies confirming better outcomes with glucose-rich dialysate [3,7,15], the clinical guidelines recommend avoiding dialysis without glucose in dialysate in diabetic patients [16]. Currently, at our institution dialysis is being performed with dialysate without glucose in chronic patients.…”

“…We must take into consideration the facts that the group of patients was small and the possible selection bias of stable patients, excluding the most fragile ones and those requiring urgent dialysis in life threatening situations. In respect of the subgroup of diabetic patients, Burmeister [3] found them at higher risk because of lower pre-dialysis glycaemia. In our study, the first dialysis was performed with glucose in the dialysis fluid and the second without.…”

“…The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycaemia in diabetic renal 10.2478/prilozi-2020-0003 patients, especially in those with presumed better glycaemic control. Risk of hypoglycaemia during haemodialysis in diabetic patients is related to lower pre-dialysis glycaemia [3]. Many influencing factors emerging from the glucose metabolism and its disorders in end-stage renal disease have been studied [4,5].…”

Dialysis Procedures Alter Metabolic Conditions

“…For patients with diabetes mellitus the risk for hypo- and hyperglycemia needs to be considered [76], and it can well motivate to maintain a glucose containing dialysate in these patients. …”