Managing diabetes in dialysis patients

O'Toole, Sam; Fan, Stanley; Yaqoob, Mohammed; Chowdhury, Tahseen A

doi:10.1136/postgradmedj-2011-130354

Cited by 29 publications

(22 citation statements)

References 66 publications

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“…This could be related to the higher morbidity and mortality that these patients suffer from cardiovascular disease, alongside other problems such as more frequent loss of vascular access. 22 The incidence of patients starting RRT for diabetic nephropathy is rising with a corresponding increase in the challenge to preserve quality of life for these patients.…”

Section: Transplant Datamentioning

confidence: 99%

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Collection and determinants of patient reported outcome measures in haemodialysis patients in Scotland

Nimmo

Bell

Brunton

et al. 2017

QJM: An International Journal of Medicine

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Collection and determinants of patient reported outcome measures in haemodialysis patients in ScotlandNimmo, A.; Bell, S.; Brunton, C.; Campbell, J.; Doyle, A.; Mackinnon, B.; Peel, R. K.; Robertson, S.; Shilliday, I.; Spalding, E.; Traynor, J. P.; Metcalfe, W.; On behalf of the Scottish Renal Registry General rights Copyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain.• You may freely distribute the URL identifying the publication in the public portal. There were significant differences in PROMs with age, SIMD quintile and primary renal diagnosis. Achieving a urea reduction ratio of >65% and dialysing through arteriovenous access were associated with significantly higher PROMs. PROMs were not affected by haemoglobin or phosphate concentration. Conclusions:Routine collection of PROMs is feasible and can identify potentially under-recognised and treatable determinants to quality of life. The association between attaining recommended standards of care and improved PROMs is striking. Individual and population-wide strategies are required to improve PROMs.

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Section: Transplant Datamentioning

confidence: 99%

“…60 (24) 55 (26) 30 (27) 28 (12) 38 (17) 2 (n=174) 65 (20) 57 (24) 34 (27) 30 (13) 41 (17) 3 (n=144) 67 (23) 60 (24) 38 (29) 29 (13) 42 (18) 4 (n=161) 70 (20) 63 (27) 42 (29) 32 (13) Hb<100 (n=111) 66 (22) 60 (25) 33 (26) 27 (14) 39 (18) Hb 100-120 (n=441) 67 (21) 61 (25) 37 (28) 30 (12) 42 (17) Hb>120 (n=167) 64 (24) 57 (27) 36 (29) 30 (13) 42 (17) One …”

Section: (N=172)unclassified

Collection and determinants of patient reported outcome measures in haemodialysis patients in Scotland

Nimmo

Bell

Brunton

et al. 2017

QJM: An International Journal of Medicine

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“…Within this subgroup of patients, improving diabetes control and attainment of treatment target values is known to be more difficult to achieve. 3 This audit reiterates the importance of adjusting of antihyperglycaemic medication for dialysis and non-dialysis days. Overwhelming majority of patients (57%) had hypoglycaemic episodes on days of dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…In the UK approximately one third of patients with diabetes will develop ESRD, with a significant proportion of these patients requiring Renal Replacement Therapy. 3 Hypoglycaemia is common in diabetes patient who receive maintenance haemodialysis. This is thought to be due to; impaired renal gluconeogenesis, malnutrition, and the increased half-life of antihyperglycaemic agents.…”

Section: Introductionmentioning

confidence: 99%

Conference Abstracts from 3rd joint meeting of ABCD and the Renal Association

Association¹

2017

Br J Diabetes

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“…15 As patients with type 2 diabetes evolve from chronic renal failure to ESRD, insulin requirements decrease and may disappear completely, a phenomenon known as "burnt out" diabetes. 16 While having diabetes or chronic renal failure independently raises the chance of hypoglycemia, this risk is highest when both conditions are present simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Risk of Hypoglycemia Associated With Intravenous Insulin

Sandler

Misiasz

Jones

et al. 2014

J Diabetes Sci Technol

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SymposiumThe level of glycemic control needed to improve outcomes without increasing the risk of hypoglycemia in hospitalized patients with critical illness is controversial. Achieving reasonable control of blood glucose without causing an excess risk of hypoglycemia is especially challenging in patients with ESRD, a condition commonly encountered in the critically ill.In 2001, Van den Berghe and colleague's landmark study in a surgical intensive care unit (ICU) suggested that strict blood glucose (BG) control (mean 103 mg/dL) was associated with a mortality and morbidity benefit in comparison to standard therapy (mean 153 mg/dL).1 A subsequent study of patients in the medical ICU however failed to show similar benefits and hypoglycemia was a frequent complication.2 Meta-analysis of multiple studies shows an inconsistent mortality benefit with intensive glycemic control and highlights the increased risk of hypoglycemia.3 More recently, the NICE-SUGAR study compared all-cause and cause-specific mortality and morbidity (new organ failure, bacteremia, redcell transfusion, and volume resuscitation) in over 6100 surgical and medical ICU patients treated either with an intensive insulin regimen (target BG 81-108 mg/dL) or a standard insulin regimen (target BG less than 180 mg/dL). 4 This trial concluded that intensive BG control was associated with a significant increase in the incidence of both moderate hypoglycemia (BG 41-70 mg/dL), and severe hypoglycemia (BG ≤ 40 mg/dL). Both degrees of hypoglycemia were associated with increased all-cause mortality, and particularly cardiovascular mortality. 5The cumulative effect of repeated hypoglycemia-related stress responses increases the risk of cardiac arrhythmias, neurological impairment, seizures, and death. [5][6] In light of AbstractComputerized insulin infusion protocols have facilitated more effective blood glucose (BG) control in intensive care units (ICUs). This is particularly important in light of the risks associated with hypoglycemia. End stage renal disease (ESRD) increases the risk of insulin-induced hypoglycemia. We evaluated BG control in 210 patients in 2 medical ICUs and in 2 surgical ICUs who were treated with a computerized insulin infusion program (CIIP). Our CIIP was programmed for a BG target of 140-180 mg/dL for medical ICU patients or 120-160 mg/dL for surgical ICU patients. In addition, we focused on BG control in the 11% of our patients with ESRD. Mean BG was 147 ± 20 mg/dL for surgical ICU patients and 171 ± 26 mg/ dL for medical ICU patients. Of both surgical and medical ICU patients, 17% had 1 or more BG 60-79 mg/dL, while 3% of surgical ICU and 8% of medical ICU patients had 1 or more BG < 60 mg/dL. Mean BG in ESRD patients was 147 ± 16 mg/dL similar to 152 ± 23 mg/dL in patients without ESRD. Of ESRD patients, 41% had 1 or more BG < 79 mg/dL as compared with 17.8% of non-ESRD patients (P < .01). A higher BG target for medical ICU patients as compared with surgical ICU patients yielded comparably low rates of moderate or severe hypoglycemia....

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Managing diabetes in dialysis patients

Cited by 29 publications

References 66 publications

Collection and determinants of patient reported outcome measures in haemodialysis patients in Scotland

Collection and determinants of patient reported outcome measures in haemodialysis patients in Scotland

Conference Abstracts from 3rd joint meeting of ABCD and the Renal Association

Reducing the Risk of Hypoglycemia Associated With Intravenous Insulin

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