Hemodialysis-Related Glycemic Disarray Proven by Continuous Glucose Monitoring: Glycemic Markers and Hypoglycemia

Abstract

<b>OBJECTIVE</b> <p>There is a high risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate; therefore, the inclusion of glucose in the dialysate is believed to prevent intradialytic hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose have not been determined.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We evaluated the glycemic profiles of 98 type 2 diabetes patients undergoing HD (68 men, HbA1c 6.4±1.2%, glycated albumin 20.8±6.8%) with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous glucose monitoring.</p> <p><b>RESULTS</b></p> <p>Sensor glucose level (SGL) showed a sustained decrease during HD, irrespective of the dialysate glucose concentration, and reached a nadir that was lower than the dialysate glucose concentration in 49 participants (50%). Twenty-one participants (21%) presented with HD-related hypoglycemia, defined by an SGL <70 mg/dL during HD and/or between the end of HD and their next meal. All these hypoglycemic episodes were asymptomatic. Measures of glycemic variability calculated using the SGL data (standard deviation, coefficient of variation, and range of SGL) were higher and time below range (<70 mg/dL) was lower in participants who experienced HD-related hypoglycemia than in those who did not, whereas time in range between 70 and 180 mg/dL, time above range (>180 mg/dL), HbA1c and GA of the two groups were similar.</p> <p><b>CONCLUSIONS</b></p> <p>Despite the use of dialysate containing 100–150 mg/dL glucose, diabetic HD patients experienced HD-related hypoglycemia unawareness frequently. SGL may fall well below the dialysate glucose concentration toward the end of HD.<br> </p>

Burden of impaired awareness of hypoglycemia in people with diabetes undergoing hemodialysis

“…In the study by Haboosh et al, 22 Cardiovascular and metabolic risk a 15% prevalence of IAH in individuals with diabetes undergoing peritoneal dialysis. Furthermore, Hayashi et al 23 found asymptomatic hypoglycemia in over 20% of their study participants with diabetes undergoing hemodialysis using CGM. The prevalence of severe hypoglycemia was higher in our study, with 23.6% of participants reporting at least one event in the preceding 12 months.…”