Blood glucose fluctuations in hemodialysis patients with end stage diabetic nephropathy

Jin, Yueping; Su, Xiaofei; Yin, Guoyong; Xu, Xiaohua; Lou, Ji-Zhuang; Chen, Jianjun; Zhou, Yue; Lan, Jie; Jiang, Bing; Li, Zheng; Lee, Kok-Onn; Ye, Lei; Ma, Jianhua

doi:10.1016/j.jdiacomp.2014.12.015

Cited by 45 publications

(61 citation statements)

References 19 publications

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“…This observation supports the notion that haemodialysis is an independent risk factor for GV even among the NDM-ESKD. Our study is in accordance with other studies (Table 8), which shows haemodialysis worsened glycemic control, and diabetic patients had larger GV as compared to non-diabetic patients [13,20,[22][23][24][25]. Table 8 Factors associated with glycaemic variability in diabetic population (DM: diabetes mellitus, GV: glycaemic variability, SMBG: Selfmonitoring blood glucose, CGM: continuous glucose monitoring, SD: standard deviation, CoV: co-e cient variant, MAGE: mean amplitude glucose excursion, MAG: mean absolute glucose, CONGA: continuous overall net glycaemic action, MODD: mean of daily difference, OHA: oral hypoglycaemic agent, GA: glycated albumin, DPP4-i: dipeptidyl-peptidase-4-inhibitor.…”

Section: Discussionsupporting

confidence: 93%

“…Patients were recruited from 5 private haemodialysis centres in Selangor, Malaysia. The sample size was calculated based on a study by Jin Y.P, 2015, which look at blood glucose uctuations among haemodialysis population [13]. Multiple logistic regression using G power software [14] was used by considering a model with one binary covariate X with event rate under Ho, p 1 = 0.13 and the event rate under X = 1, p 2 = 0.40, giving the odds ratio of ~ 4.5.…”

Section: Methodsmentioning

confidence: 99%

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Prevalence Of Glycaemic Variability (GV) And Factors Associated With The Glycaemic Arrays Among End-Stage Kidney Disease (ESKD) Patients On Chronic Haemodialysis.

Khan

Zakaria

Abidin

et al. 2020

Preprint

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Introduction: Glycaemic variability (GV) or glycaemic fluctuations carries a significant higher risk of diabetic-related complications, especially cardiovascular. Extensive researches have been reported, but study on the end-stage-kidney-disease (ESKD) patients on chronic haemodialysis are scarce. This study aims to determine the magnitude of GV among ESKD (diabetic vs non-diabetic) patients and its associated factors during haemodialysis day (HDD) and non-haemodialysis day (NHDD). Methods: We recruited 150 patients on haemodialysis, 93 patients had diabetic (DM-ESKD), and 57 non-diabetic (NDM-ESKD). The GV indices (standard deviation [SD] and percentage co-efficient variant [%CV]) were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles during haemodialysis and non-haemodialysis day. The GV indices and its associated factors were analysed comparing between both groups during the HDD and NHDD. Results: Mean blood glucose during HDD was 9.33 [SD 2.7, %CV 30.6%] mmol/L in DM-ESKD compared to 6.07 [SD 0.85, %CV 21.3%] mmol/L in NDM-ESKD (p =<0.01). The DM-ESKD group experienced significantly higher GV indices compared to NDM-ESKD; both during haemodialysis and non-haemodialysis day, particularly in the group with HbA1c 8-10% (p= <0.01). Presence of diabetes, older age group, hyperlipidaemia, HbA1c, ferritin levels, and albumin were recognised as factors associated with GV. Conclusion: DM-ESKD patients has high glycaemic variability, especially during the haemodialysis day, therefore increasing their chance to develop future devastating complications. We identified high HbA1c, older age group, presence of hyperlipidaemia, ferritin levels, and albumin as factors associated with GV. Since these groups of patients are vulnerable to CVD mortality, urgent attention is needed to rectify it.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Prevalence Of Glycaemic Variability (GV) And Factors Associated With The Glycaemic Arrays Among End-Stage Kidney Disease (ESKD) Patients On Chronic Haemodialysis.

Khan

Zakaria

Abidin

et al. 2020

Preprint

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“…Non-fasting samples might have affected the blood glucose, HOMA-IR and serum FGF21 levels [43]. On the other hand, it has been reported that the blood glucose level significantly decreases during a HD session that causes hypoglycemia [44]. Thus, we just used pre-dialysis blood samples, which might have included non-fasting samples.…”

Section: Discussionmentioning

confidence: 99%

Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease

et al. 2017

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Fibroblast growth factor 21 (FGF21) is an endocrine factor that regulates glucose and lipid metabolism. Circulating FGF21 predicts cardiovascular events and mortality in type 2 diabetes mellitus, including early-stage chronic kidney disease, but its impact on clinical outcomes in end-stage renal disease (ESRD) patients remains unclear. This study enrolled 90 ESRD patients receiving chronic hemodialysis who were categorized into low- and high-FGF21 groups by the median value. We investigated the association between circulating FGF21 levels and the cardiovascular event and mortality during a median follow-up period of 64 months. A Kaplan-Meier analysis showed that the mortality rate was significantly higher in the high-FGF21 group than in the low-FGF21 group (28.3% vs. 9.1%, log-rank, P = 0.034), while the rate of cardiovascular events did not significantly differ between the two groups (30.4% vs. 22.7%, log-rank, P = 0.312). In multivariable Cox models adjusted a high FGF21 level was an independent predictor of all-cause mortality (hazard ratio: 3.98; 95% confidence interval: 1.39–14.27, P = 0.009). Higher circulating FGF21 levels were associated with a high mortality rate, but not cardiovascular events in patient with ESRD, suggesting that circulating FGF21 levels serve as a predictive marker for mortality in these subjects.

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“…An increase in post-dialysis systolic blood pressure is associated with an increased risk of cardiovascular mortality and other causes for the next four years. This can indicate the occurrence of excess fluid volume in patients subclinically, so it is recommended to evaluate the status of the fluid 18 .…”

Section: Tabel 2 Comparison Of Blood Pressure Before and After Hemodmentioning

confidence: 99%

Comparison of Blood Pressure and Blood Glucose Levels in Chronic Kidney Failure Patients Before and After Hemodialysis Treatment in RSMH Palembang

Berlin

Oswari

Susilawati

2019

MKS

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Gagal ginjal kronik ditandai dengan menurunnya fungsi ginjal secara ireversibel yang telah berlansung lebih dari tiga bulan dengan nilai laju filtrasi glomerulus kurang dari 15 ml/menit/1,73m2. Hemodialisis merupakan salah satu terapi pengganti ginjal yang paling sering dilakukan, namun hemodialisis memiliki komplikasi terhadap perubahan tekanan darah dan kadar gula darah. Penelitian ini bertujuan untuk mengetahui perbandingan tekanan darah dan kadar gula darah pada pasien gagal ginjal kronik sebelum dan sesudah hemodialisis di unit hemodialisis RSUP dr. Mohammad Hoesin Palembang. Penelitian ini merupakan penelitian observasional analitik dengan desain longitudinal menggunakan pengukuran berulang. Subjek penelitian adalah 74 pasien gagal ginjal kronik yang memenuhi kriteria inklusi dan eksklusi. Data penelitian diperoleh melalui data primer (pengukuran dan wawancara) dan dianalisis menggunakan Paired T-Test dan Wilcoxon. Rata-rata tekanan darah sebelum hemodialisis adalah 150,14 ± 30,045 mmHg (sistolik) dan 83,99 ± 16,469 mmHg (diastolik) serta sesudah hemodialisis adalah 159,66 ± 33,570 mmHg (sistolik) dan 86,35 ± 15,534 mmHg (diastolik). Rata-rata kadar gula darah sebelum hemodialisis adalah 161,61 ± 80,750 mg/dl serta sesudah hemodialisis adalah 131,51 ± 49,430 mg/dl. Hasil uji Paired T-Test menunjukkan perbandingan tekanan sistolik yang signifikan (p = 0,007), sedangkan hasil uji Wilcoxon menunjukkan perbandingan diastolik yang tidak signifikan (p = 0,193) dan perbandingan kadar gula darah yang signifikan (p = 0,000). Terdapat perbandingan tekanan darah sistolik yang signifikan, tekanan darah diastolik yang tidak signifikan, dan kadar gula darah yang signifikan sebelum dan setelah hemodialisis pada pasien gagal ginjal kronik di RSUP dr. Mohammad Hoesin Palembang.

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Blood glucose fluctuations in hemodialysis patients with end stage diabetic nephropathy

Cited by 45 publications

References 19 publications

Prevalence Of Glycaemic Variability (GV) And Factors Associated With The Glycaemic Arrays Among End-Stage Kidney Disease (ESKD) Patients On Chronic Haemodialysis.

Prevalence Of Glycaemic Variability (GV) And Factors Associated With The Glycaemic Arrays Among End-Stage Kidney Disease (ESKD) Patients On Chronic Haemodialysis.

Association between circulating fibroblast growth factor 21 and mortality in end-stage renal disease

Comparison of Blood Pressure and Blood Glucose Levels in Chronic Kidney Failure Patients Before and After Hemodialysis Treatment in RSMH Palembang

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