Carbohydrate metabolism in uraemia

Rigalleau, Vincent; Gin, H.

doi:10.1097/01.mco.0000172590.32564.b9

Cited by 54 publications

(44 citation statements)

References 113 publications

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“…It is well known mild or severe hypoglycemic episodes are associated with an increased risk of cardiovascular events, hospitalization and mortality [13]. ESRD patients are subjected to hypoglycemia because of impaired renal gluconeogenesis, malnutrition, altered pharmacokinetics of insulin and hypoglycemic agents [14,15]. Although the risk of hypoglycemia could be reduced by using glucose-enriched dialysate fluids [16,17,18], glycemic patterns are still hardly predictable.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Pattern in Diabetic Patients on Hemodialysis: Continuous Glucose Monitoring (CGM) Analysis

Giusti¹,

Merlo²,

Dellepiane³

et al. 2014

Blood Purif

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Background/Aims: Recent evidences suggest that hemodialysis (HD) induces glycemic variations in diabetic patients. Continuous glucose monitoring (CGM) devices measure interstitial glucose in a ‘Holter-like' manner thereby improving the glycemic control assessment method. Methods: A CGM device (Medtronic iPRO) was used on 12 diabetic patients with chronic HD for 6 days to assess intra- and extra-dialytic interstitial glucose. Results: In all enrolled patients, HD was associated with a decrease of interstitial glucose values. Intradialytic glucose nadir was 79 mg/dl and it was reached at the third hour after the beginning of the session. At the end of HD, interstitial glucose increased in all patients and a glycemic peak (187 mg/dl) occurred after an average time of 2.5 h. No episodes of nocturnal hypoglycemia occurred. Conclusion: HD is associated with significant intradialytic reduction of glycemia and postdialytic hyperglycemia. CGM devices result in better monitoring of glycemic trends in diabetic patients on chronic HD and could improve insulin management.

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Section: Discussionmentioning

confidence: 99%

Glycemic Pattern in Diabetic Patients on Hemodialysis: Continuous Glucose Monitoring (CGM) Analysis

Giusti¹,

Merlo²,

Dellepiane³

et al. 2014

Blood Purif

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“…Nondiabetic CKD patients also have glucose intolerance, probably because of peripheral insulin resistance [21]. Besides insulin resistance, reduced insulin-mediated non-oxidative glucose disposal is the most evident defect of glucose metabolism, but impairments of glucose oxidation, the defective suppression of endogenous glucose production, and abnormal insulin secretion also contribute to uremic glucose intolerance [22]. Reduced insulin-mediated non-oxidative glucose disposal is the most evident defect of glucose metabolism in CKD patients.…”

Section: Disorders Of Carbohydrate and Lipid Metabolismmentioning

confidence: 99%

Malnutrition in patients with chronic kidney disease

Chung¹,

Koh²,

Shin³

et al. 2012

OJIM

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Malnutrition is a major issue in patients with chronic kidney disease (CKD), adversely affecting morbidity, mortality, functional activity and patients’ quality of life. Our knowledge of the pathogenic mechanisms of malnutrition in patients with CKD, including endstage renal disease, has been improved. This has led to the development of clinical practice guidelines for nutritional care in CKD which provide a framework for the nutritional issues facing patients and physiccians. Extensive research in the field of nutrition in patients with CKD has resulted in the formation of general guidelines, although some uncertainties still exist on some of the best therapeutic or preventive options in uremic malnutrition. It is important to search actively for malnutrition since early diagnosis and treatment can improve the prognosis for CKD patients and reduce the monetary costs connected with treatment

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“…9 These abnormalities are observed in dialyzed patients as well as in patients with mild or moderate CKD. A recent article 10 suggested that an increased level of urea, which has since long been considered to have negligible toxicity, could be the link between these 2 abnormalities.…”

Section: Insulin Resistance and Oxidative Stressmentioning

confidence: 97%