Effect of different levels of glucose in the dialysate on the risk of hypoglycaemia during hemodialysis in diabetic patients

Burmeister, Jayme Eduardo; Campos, Juliana Fernandes; Miltersteiner, Diego da Rosa

doi:10.5935/0101-2800.20120020

Cited by 9 publications

(10 citation statements)

References 26 publications

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“…However, a significant BG drop was seen during hemodialysis on the hemodialysis day. Asymptomatic hypoglycemia has been reported in hemodialysis patients during hemodialysis [25,57,58]. It has long been thought that the diffusion of glucose from blood to dialysate causes this hypoglycemia, and that the use of glucose-containing dialysate can prevent such hypoglycemia [11,57,59].…”

Section: Discussionmentioning

confidence: 99%

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

et al. 2020

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“…Glucose-added hemodialysates (commonly 100 to 200 mg per deciliter) significantly reduced hypoglycemia in ESRD receiving HD [34, 35]. In addition, higher hemodialysate glucose concentration significantly reduced more hypoglycemia compared with lower hemodialysate glucose concentration [36, 37]. The glucose concentrations of peritoneal dialysates are much higher than those of hemodialysates.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

et al. 2017

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BackgroundPatients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis.MethodsUsing National Health Insurance Research Database, 20,845 advanced DKD patients beginning long-term dialysis between 2002 and 2006 were enrolled. We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis.Results19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend < 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia. However, previous severe hypoglycemia was not correlated with risk of MI after dialysis.ConclusionsThe rate of severe hypoglycemia was high in advanced DKD patients. Patients with higher aDCSI scores tended to have more hypoglycemic episodes. Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients.

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“…Hypoglycemia was considered as a blood glucose level under 70 mg/dL even without symptoms, as stated in previous studies (2,3). Other details of the study were decribed in the original article (5 For the present analysis, we compared pre-HD with intra-HD average glycemia in each phase, both in those patients who presented HG episodes as in those without HG. We also studied specifically those patients with pre-HD glycemia under 140 mg/dL in each phase, comparing pre-HD to intra-HD average glycemia in each phase.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, the use of glucose-added dialysate showed a significant reduction and even the absence of intradialytic HG (3), and nowadays its use is indicated and largely diffused (4). Recently, we published a study in which we compared the occurrence of HG during dialysis with different levels of glucose (5). Now we revised these data in order to verify the hypothesis that intradialytic HG episodes in DM patients could be related to pre-dialysis serum glucose levels.…”

Section: Introductionmentioning

confidence: 99%

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

Burmeister

Miltersteiner

Burmeister

et al. 2015

Arch. Endocrinol. Metab.

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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

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Effect of different levels of glucose in the dialysate on the risk of hypoglycaemia during hemodialysis in diabetic patients

Cited by 9 publications

References 26 publications

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

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

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