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Occult hypoglycemia caused by hemodialysis
M A Jackson1, M R Holland, J Nicholas
1Renal Dialysis Unit, New Cross Hospital, Wolverhampton, England.
Clinical Nephrology
|May 7, 1999
Summary
Hemodialysis can cause asymptomatic hypoglycemia in non-diabetic patients due to glucose-free dialysis fluid. Using dialysis fluid with at least 5.5 mmol/l glucose is recommended for at-risk patients.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Disorders
Background:
- Hypoglycemia in hemodialysis patients has been overlooked.
- Asymptomatic plasma glucose drops may not be clinically recognized.
- This study investigates hemodialysis effects on glucose and hormones in non-diabetics.
Purpose of the Study:
- To assess the impact of hemodialysis on plasma glucose levels.
- To evaluate hormonal responses (insulin, glucagon, cortisol, catecholamines) during hemodialysis.
- To identify risks and recommend interventions for hypoglycemia in non-diabetic hemodialysis patients.
Main Methods:
- 21 non-diabetic chronic renal failure patients underwent hemodialysis with glucose-free fluid.
- Patients avoided medication and eating during the first hour of dialysis.
- Blood and dialysate samples were collected for analysis during the initial hour.
Main Results:
- Plasma glucose dropped below 4.0 mmol/l in 9 patients, with a lowest value of 2.1 mmol/l.
- Glucose loss into the dialysate averaged 6 g/h.
- Patients with initial glucose ≤4.5 mmol/l were at higher risk; subsequent dialysis with glucose-containing fluid stabilized glucose levels.
Conclusions:
- Hemodialysis can lead to unrecognized hypoglycemia in non-diabetic patients.
- Hormonal responses to hypoglycemia during dialysis are blunted.
- A minimum of 5.5 mmol/l glucose in dialysis fluid is advised for at-risk individuals.