Fatal hypoglycaemia occurring after peritoneal dialysis.

Greenblatt, D. J.

doi:10.1136/bmj.2.5808.270

Cited by 23 publications

(4 citation statements)

References 7 publications

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“…Severe hyperglycemia is often asymp tomatic [15,16], but can rarely cause mortality from hyperkalemia [17] or hypertonicity [18]. Frequent hyper glycemia is associated with shortened survival [4], Hypo glycemia directly causes death in a small percent of dia betics on dialysis [3,4,[19][20][21], Long duration of diabetes and poor glycemic control were the only risk factors for DGP discovered by logistic regression. This association offers the hope of prevention of DGP with better glucose control.…”

Section: Discussionmentioning

confidence: 99%

Gastroparesis in Diabetics on Chronic Dialysis: Clinical and Laboratory Associations and Predictive Features

Eisenberg

Murata²,

Tzamaloukas

et al. 1995

Nephron

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Clinical and laboratory features and risk factors for diabetic gastroparesis (DGP) were investigated in 226 diabetics on chronic dialysis; 106 subjects (43%) had DGP diagnosed by persistent vomiting improved with the use of prokinetic agents and 120 (control group) had no clinical DGP. Type 1 diabetics had DGP more frequently than type 2 diabetics (70 vs. 37%). The DGP group had longer duration of diabetes (21 ± 8 vs. 13 ± 6 years), higher frequency of diabetic orthostatic hypotension (95 vs. 33%), enteropathy (49 vs. 5%), blindness (52 vs. 23%), myocardial infarction (86 vs. 42%), extremity gangrene (54 vs. 27%) and cerebrovascular accidents (43 vs. 25%), lower serum albumin 32.3 ± 3.9 vs. 35.4 ± 3.8 g/l), urea (24.0 ± 5.5 vs. 25.5 ± 5.5 mmol/l) and creatinine (710 ± 210 vs. 820 ± 220 μmol/l), and higher serum TCO₂ (20.9 ± 3.1 vs. 19.8 ± 2.7 mmol/l) than the control group (all differences significant at p ± 0.004). Glycemic control was adequate in 24% of the DGP group subjects and 83% of the control subjects (p < 0.001). Annual hospitalization rate was 49 ± 48 days/patient in the DGP group and 16 ± 27 days/patient in the control group (p < 0.001). Median patient survival was 24 ± 2 months in the DGP group and 61 ± 9 months in the control group (p < 0.0001). Logistic regression identified long duration of diabetes and poor glycemic control as risk factors for DGP. In diabetics on dialysis, DGP is associated with high frequency of other diabetic complications, low serum albumin and creatinine, and high morbidity and mortality. Efforts to improve glycemic control in the hope of delaying DGP appear to be worthwhile.

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Section: Discussionmentioning

confidence: 99%

Gastroparesis in Diabetics on Chronic Dialysis: Clinical and Laboratory Associations and Predictive Features

Eisenberg

Murata²,

Tzamaloukas

et al. 1995

Nephron

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“…[46] concerning recurrent and fatal hypoglycemia in a patient with chronic renal failure, suggests that this problem may be more frequent than was previously recognized. Hypoglycemia has also occurred as a complication of peritoneal [51] and hemodialysis [52,114], and points to the necessity of monitoring blood glucose concentrations in the immediate postdialysis period.…”

Section: Hypoglycemia In Renal Failurementioning

confidence: 99%

Insulin and the Kidney

Rubenstein

Mako

Horwitz

1975

Nephron

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Changes in renal function and structure are frequently observed in patients with diabetes mellitus. In the early phases of the disease, alterations in glomerular filtration rate, renal plasma flow, glomerular permeability and tubular capacity for glucose reabsorption occur. In the late stages of juvenile onset diabetes, renal failure is a common cause of death. For this reason, increasing attention is being paid to the possibility of long-term dialysis and renal transplantation in these patients. The kidneys play an important role in regulating insulin metabolism. The renal arteriovenous difference is approximately 30–45% and a linear relationship exists between the arterial insulin level and the renal arteriovenous concentration difference. The renal extraction of insulin is 200 ml/min in man, and it is estimated that 6–8 U are removed and degraded by the kidney in 24 h. The quantity of insulin in urine is small. However, its clearance is relatively constant over a wide range of serum concentrations and is 0.15–0.5 ml/min. The mean basal insulin excretion is 3.6 µU/mg creatinine, and a fourfold rise occurs following a glucose load. The urinary insulin values in neonates, children and patients with diabetes and renal failure are reviewed. In diabetic patients, progressive renal disease is accompanied by decreasing insulin requirements. In contrast, nondiabetic patients who develop renal failure frequently show abnormalities in carbohydrate metabolism, the commonest of which is a pseudodiabetic state.

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“…Hemodialysis may also predispose patients to hypoglycemia 18 or in some cases lead to severe hypoglycemia in patients with impaired renal function. 19 Although the need for dosage adjustment may arise when a significant fraction of drug or active metabolite is removed by the hemodialysis process, results from this study demonstrated that the hemodialysis procedure was unlikely to result in significant elimination of LY2605541. In this study, only a small fraction of LY2605541 was eliminated during a single hemodialysis session of LY2605541.…”

Section: Discussionmentioning

confidence: 69%

“…Compared with the other patients who did not experience hypoglycemia, LY2605541 exposures (both C max and AUC) were not higher in the patients with ESRD, who may be more susceptible to hypoglycemia because of altered glucose homeostasis related to decreased kidney function. Hemodialysis may also predispose patients to hypoglycemia18 or in some cases lead to severe hypoglycemia in patients with impaired renal function 19…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of the Long‐Acting Basal Insulin LY2605541 in Subjects With Varying Degrees of Renal Function

Linnebjerg

Choi

Lam

et al. 2016

Clinical Pharm in Drug Dev

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The pharmacokinetics of LY2605541 (basal insulin peglispro), a novel long‐acting basal insulin analogue, was evaluated in 5 groups of subjects with varying degrees of renal function based on creatinine clearance: normal renal function (>80 mL/min), mild renal impairment (51–80 mL/min), moderate renal impairment (30–50 mL/min), severe renal impairment (<30 mL/min), or end‐stage renal disease (ESRD) requiring hemodialysis. Serial blood samples for pharmacokinetic analyses were collected up to 12 days following a single 0.33 U/kg subcutaneous dose of LY2605541. The apparent clearance (CL/F) and half‐life across groups were not affected by renal function. Cmax values were lower in subjects with increasing severity of renal impairment; however, the small decrease in Cmax did not affect the overall exposure. Regression analysis showed that LY2605541 clearance is independent of renal function (slope = 0.000863; P = .885). The mean fraction of LY2605541 eliminated by a single hemodialysis session was 13% in subjects with ESRD. LY2605541 was generally well tolerated in healthy subjects and those with renal impairment following a single 0.33 U/kg subcutaneous dose. Given these data, no dose adjustment of LY2605541 based on pharmacokinetics is recommended in renal impairment or in patients undergoing hemodialysis.

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Fatal hypoglycaemia occurring after peritoneal dialysis.

Cited by 23 publications

References 7 publications

Gastroparesis in Diabetics on Chronic Dialysis: Clinical and Laboratory Associations and Predictive Features

Gastroparesis in Diabetics on Chronic Dialysis: Clinical and Laboratory Associations and Predictive Features

Insulin and the Kidney

Pharmacokinetics of the Long‐Acting Basal Insulin LY2605541 in Subjects With Varying Degrees of Renal Function

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