Glycemic and lipidic profile in diabetic patients undergoing dialysis

Abstract

Objective: The aim of this study is to assess the clinical care pattern and to compare the lipid and glycemic profile in a group of diabetic patients undergoing both hemodialysis (HD) and peritoneal dialysis (PD) and to correlate these data using biomarkers of cardiovascular risk. Subjects and methods: The first phase consisted in performing a survey on demographic data, questions about the medical team and glycemic control. In the second phase, patients were assessed through laboratorial data on their glycemic and lipid profile at a single center for HD and PD. Results: 91 patients was the total population; 70 patients (77%) answered the survey; 66 patients (94%) considered the nephrologist the physician responsible for caring for their glycemic control. Second phase: 59 patients were assessed, 29 undergoing HD and 30 undergoing PD. Fifty-seven percent of the patients had HbA1c above 7%; the level of glycemic markers in patients undergoing peritoneal dialysis was significantly higher than in patients undergoing hemodialysis: HbA1c (9.37 ± 0.5) vs. (7.37 ± 0.49) p < 0.01; fasting glycemia (170 ± 15) vs. (126 ± 15) mg/dL p < 0.05. We found a positive correlation between HbA1c and hyperfibrinogenemia (r = 0.4437, p < 0.0005). Conclusions: The data reveal that glycemic control in diabetic patients undergoing renal replacement therapy (RRT) is neglected. Peritoneal dialysis is related to the worst level of glycemic markers, possibly due to the glucose content in the dialysis solution, and higher levels from HbA1c have a positive correlation with hyperfibrinogenesis in this population. Arq Bras Endocrinol Metab. 2010;54(9):793-800 Keywords Glycemic control; insulin resistance; chronic kidney disease; peritoneal dialysis; inflammation RESUMO Objetivo: Avaliar as características dos cuidados clínicos dos pacientes em diálise, comparar o controle glicêmico e lipídico entre os pacientes diabéticos em hemodiálise (HD) e em diálise peritoneal (DP) e correlacionar os dados laboratoriais com biomarcadores de risco cardiovascular. Sujeitos e métodos: A primeira etapa consistiu de um questionário abordando variáveis demográficas, questões sobre a equipe multidisciplinar, incluindo a equipe médica e sobre o controle glicêmico. Na segunda, os pacientes foram avaliados com exames laboratoriais para controle glicêmico e perfil lipídico numa unidade de HD e DP. Resultados: Dos 91 pacientes avaliados, setenta (77%) responderam ao questionário. Destes, 66 (94%) consideraram o nefrologista o médico responsá-vel pelo cuidado do seu controle glicêmico. Na segunda etapa, foram avaliados 59 pacientes: 29 em HD e 30 em DP. Cinquenta e sete por cento dos pacientes diabéticos em diálise apresentaram HbA1c acima de 7%, sendo que aqueles em diálise peritoneal apresentam níveis de marcadores glicêmicos significativamente piores do que os pacientes diabéticos em HD, HbA1c: (9,37 ± 0,5) vs. (7,37 ± 0,49) p < 0.01; glicemia de jejum: (170 ± 15) vs. (126 ± 15) mg/dL, p < 0.05. Encontramos uma correlação positiva entre HbA1c e hiperfibrinoge...

Diabetes decreases patency of tunneled catheters in hemodialysis patients after first effective thrombolysis with urokinase

“…Maintenance of the venous catheter is followed by chronic irritation and repeated injury of the endothelial layer of the vein that predispose for the formation of microthrombi [ 14 ]. Prothrombotic state in DM is explained by endothelial injury, hyperfibrinogenaemia and platelet hyperreactivity related to increased glucose levels as well as insulin resistance and hyperinsulinemia [ 15 ]. It was shown that even strict glucose control does not normalize activation of the coagulation system in DM patients [ 16 ].…”

Coordenação de cuidados primários para o paciente com doença renal crônica em diálise: revisitando papéis

“…No estudo de Fortes et al 21 (2010), 94% dos pacientes em diálise consideraram o nefrologista o médico responsável por zelar pelo seu controle glicêmico. Todavia 57% dos pacientes tinham HbA1c acima do valor considerado adequado à época.…”

“…Todavia 57% dos pacientes tinham HbA1c acima do valor considerado adequado à época. Pacientes em DP apresentavam valores de HbA1c significativamente maiores quando comparados aos de pacientes em HD (9,37 ±0,5) vs (7,37 ±0,49), p <0,01 21 .…”

Extensão Universitária Voltada À Saúde Mental De Gestantes Dentro Da Atenção Primaria a Saúde

“…Os dados para a formatação do questionário foram selecionados a partir das informações contidas na literatura. (Deighan C. J, 2000 ;Fortes P. C, 2010).…”