Haemodialysis-induced hypoglycaemia and glycaemic disarrays

Abstract

In patients with diabetes receiving chronic haemodialysis, both very high and low glucose levels are associated with poor outcomes, including mortality. Conditions that are associated with an increased risk of hypoglycaemia in these patients include decreased gluconeogenesis in the remnant kidneys, deranged metabolic pathways, inadequate nutrition, decreased insulin clearance, glucose loss to the dialysate and diffusion of glucose into erythrocytes during haemodialysis. Haemodialysis-induced hypoglycaemia is common during treatments with glucose-free dialysate, which engenders a catabolic status similar to fasting; this state can also occur with 5.55 mmol/l glucose-containing dialysate. Haemodialysis-induced hypoglycaemia occurs more frequently in patients with diabetes than in those without. Insulin therapy and oral hypoglycaemic agents should, therefore, be used with caution in patients on dialysis. Several hours after completion of haemodialysis treatment a paradoxical rebound hyperglycaemia may occur via a similar mechanism as the Somogyi effect, together with insulin resistance. Appropriate glycaemic control tailored for patients on haemodialysis is needed to avoid haemodialysis-induced hypoglycaemia and other glycaemic disarrays. In this Review we summarize the pathophysiology and current management of glycaemic disarrays in patients on haemodialysis.

Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D)

“…As a consequence, drug therapy needs to be modified to reduce the risk of hypoglycemia whichbesides hyperglycemia -can negatively affect the outcome of DM patients. Therefore, in DM CKD-G5D good glycemic control remains important to prevent or delay the progression of the vascular complications, to reduce cardiovascular disease (CVD) morbidity and mortality [10,11], and to avoid hypoglycemia-related mortality [12,13].…”

Frequent falls and confusion: recurrent hypoglycemia in a patient with tuberous sclerosis complex

“…Interestingly, this patient developed hypoglycemia while on hemodialysis, despite the use of a glucose‐containing dialysate (1 g/L). Typically, glucose‐containing dialysates reduce the occurrence of hypoglycemia, although hypoglycemia can still occur especially in higher insulin states . This case emphasizes the need to consider and recognize hypoglycemia as an important differential diagnosis in such circumstances.…”

Glycemic Variability and Hemodialysis

“…12,13 Glisemik dalgalanmalar, HD tedavisi boyunca plazma glukoz konsantrasyonu (glukoz kaybı ve plazma glukozunun eritrositler içerisine kayması) ve plazma insülin düzeyindeki azalma (küçük molekül büyüklüğü moleküler ağırlık 6,2 kDa-nedeni ile), insülinin difüzyon ve/veya konveksiyon mekanizmaları ile uzaklaştırılması, ayrıca HD sıra-sında plazma insülinin membran tarafından adsorpsiyonu nedeni ile oluşabilmektedir. [14][15][16][17] Gai ve ark.nın yaptığı 12 HD hastasının 48 saatlik SGTS ile takip edildiği çalışmada; ortalama glukoz düzeyinin HD gününde, HD yapılmadığı güne göre daha yüksek olduğu ve 48 saatlik takip sonunda hiperglisemik sürenin HD gününde daha fazla olduğu saptanmıştır. Ayrıca SD ve MAGE dü-zeyleri HD gününde daha yüksek bulunmuştur.…”