Effects of Hemodialysis and Peritoneal Dialysis on Glycometabolism in Patients with End-Stage Diabetic Nephropathy

Abstract

<b><i>Objective:</i></b> The objective is to study the fluctuation pattern of blood glucose spectrum in patients with end-stage diabetic nephropathy (ESDN) receiving hemodialysis (HD) and peritoneal dialysis (PD), respectively, and to compare the influences of these 2 dialysis methods on glycometabolism. <b><i>Methods:</i></b> Sixty-four dialysis patients with ESDN were recruited, including 35 HD patients and 29 PD patients. The 24-h blood glucose on dialysis days of the 2 groups was monitored by the continuous glucose monitoring system, and the relevant glycometabolism indexes were recorded and compared. <b><i>Results:</i></b> The control of blood glucose in both groups was not satisfactory. At the same blood glucose level, the dosage of exogenous insulin needed by patients in the PD group was larger than that in the HD group (<i>p</i> < 0.05). However, the fluctuation of blood glucose and consequently the incidence of hyperglycemia and hypoglycemia in HD group were greater than that in PD group (<i>p</i> < 0.05). The patients’ blood glucose levels decreased progressively during the course of HD. The mean blood glucose (MBG) values estimated by glycosylated hemoglobin (HbA1c) in both groups were lower than the actual measured blood glucose values (<i>p</i> < 0.05). Preliminary correlation analysis showed that the deviation of the MBG values estimated by HbA1c was positively correlated with the degree of anemia. <b><i>Conclusion:</i></b> HD patients have larger glycemic variability as compared with PD patients, while PD patients have overall increased blood glucose levels. Hypoglycemic programs should be made according to the corresponding changes in blood glucose. The HbA1c value of dialysis patients has a large deviation, so it is necessary to explore its influencing factors and develop more accurate blood glucose assessment indicators.

Continuous glucose monitoring in an end‐stage renal disease patient with diabetes receiving hemodialysis

“…Conversely, falsely low HbA1c values and underestimation of glycemic levels may be observed with anemia, blood transfusions, frequent utilization of erythropoietin‐stimulating agents, or conditions associated with shortened erythrocyte life spans (e.g., hemoglobinopathies, erythrocyte fragility due to uremia, and erythrocyte lysis due to dialysis). Indeed, in a study of 64 dialysis patients with diabetes who underwent concurrent glycemic assessment by HbA1c and CGM, mean blood glucose levels estimated from HbA1c levels were lower than the CGM‐measured glucose values 23 . Even in the absence of CKD, the association of mean glucose to HbA1c may show wide variation 15,24 .…”