Comparable Hemodilution with Hypertonic Glucose in Patients with and without Type-2 Diabetes Mellitus during Hemodialysis

Abstract

(1) Background: It was examined whether glucose-induced changes in the relative blood volume are suitable to identify subjects with and without type-2 diabetes mellitus (T2D) during hemodialysis. (2) Methods: The relative blood volume was continuously recorded during hemodialysis and perturbed by the infusion of glucose comparable to the dose used for intravenous glucose tolerance tests. Indices of glucose metabolism were determined by the homeostatic model assessment (HOMA). Body composition was measured by a bioimpedance analysis. The magnitude and the time course of hemodilution were described by a modified gamma variate model and five model parameters. (3) Results: A total of 34 subjects were studied, 14 with and 20 without T2D. The magnitude of the hemodilution and the selected model parameters correlated with measures of anthropometry, body mass index, absolute and relative fat mass, volume excess, baseline insulin concentration, and HOMA indices such as insulin resistance and glucose disposition in a continuous analysis, but were not different in a dichotomous analysis of patients with and without T2D. (4) Conclusions: Even though the parameters of the hemodilution curve were correlated with measures of impaired glucose metabolism and body composition, the distinction between subjects with and without T2D was not possible using glucose-induced changes in the relative blood volume during hemodialysis.

Cardiovascular Response to Intravenous Glucose Injection during Hemodialysis with Assessment of Entropy Alterations

“…This increase was explained by a blood volume expansion in the range of 5%. A similar effect can be assumed in this study population, where the blood volume expansion was of comparable magnitude in both NDO and DM patient groups [19]. AAPE(fiSYS), AAPE(fiDIA), and AAPE(fiMAP) increased in NDO and rose in DM after glucose injection, but in DM, this result was not statistically significant.…”

“…This is the continuation of a study performed in a group of CKD patients with (DM) and without type-2 diabetes mellitus (NDO) treated with hemodialysis in the Dialysis Department of the Military Institute of Medicine in Warsaw, Poland, reported previously [17,18]. More information about material and methods is found in these publications and in companion papers of this study [19,20].…”

Changes of Hemodynamic Parameters after Intradialytic Glucose Injection

“…The time course and the magnitude of the perturbation was comparable to that of an intravenous glucose tolerance test, but it was completed during hemodialysis. This perturbation not only has metabolic effects that were analyzed and discussed previously but also the significant hemodynamic and blood volume effects analyzed and discussed in this article and in companion papers published in the same journal [ 19 , 20 ].…”

“…In our study, we found that on average the infusion of glucose caused higher SBP from 5 to 20 min after glucose infusion, followed by a slight (statistically insignificant) decrease lasting until the end of dialysis. This increase is essentially caused by the osmotic action of glucose expanding the circulating blood volume and which is studied in a companion paper [ 20 ]. Changes of DBP after glucose infusion were also observed, but DBP increased significantly between 60 and 120 min of HD, long after the direct glucose effect had disappeared, and remained higher until the end of dialysis, similarly to MAP.…”

“…The drop of PP was reported from the second hour to the end of HD because of the rise in DBP from the second hour to the end of HD ( Table 2 ). The acute changes are essentially explained by glucose-induced blood volume expansion and by the resulting increase in cardiac output, studied in previous and companion publications [ 20 , 28 ]. We also found significantly higher PP in diabetic patients compared to non-diabetic individuals ( p = 0.012).…”