Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia

Objective To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. Subjects and methods Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. Results Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 - t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. Conclusions The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control.

研究目的 对比不同透析前血糖水平的慢性肾脏病（chronic kidney disease）合并糖尿病患者，在使用含葡萄糖与不含葡萄糖的透析液（dialysis solutions）时，其血液透析（hemodialysis）过程中低血糖（hypoglycemia）事件的发生情况。研究对象与方法 纳入20例行维持性血液透析（maintenance hemodialysis）的2型糖尿病患者，依次完成3次间隔7天的透析疗程，分别使用不含葡萄糖的透析液、葡萄糖浓度为55mg/dL的透析液以及葡萄糖浓度为90mg/dL的透析液。分别于透析前即刻及透析过程中的4个时间点检测血糖水平，将血糖值低于70mg/dL定义为低血糖事件。研究结果 无论使用不含葡萄糖的透析液（140.4±50.7 vs 277.7±91.0 mg/dL；p=0.005；95%CI：46.4~228.1）还是55mg/dL葡萄糖浓度的透析液（89.5±10.6 vs 229.7±105.0 mg/dL；p<0.05；95%CI：9.8~270.5），发生透析中低血糖的患者，其透析前平均血糖水平均低于未发生低血糖者。在透析前血糖水平低于140mg/dL的患者中，仅在使用不含葡萄糖的透析液时，其透析中平均血糖水平显著低于透析前血糖水平（p<0.0001；95%CI：29.9~56.0，t检验）。透析中低血糖仅在使用不含葡萄糖或低葡萄糖浓度透析液时被观测到。研究结论 对于糖尿病肾病患者，使用不含葡萄糖或低葡萄糖浓度的透析液会显著增加透析中低血糖的发生风险，尤其在血糖控制情况被认为较好的患者中更为显著。