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Hemodialysis-induced hypoglycemia in diabetic patients
M A Jackson1, M R Holland, J Nicholas
1Renal Dialysis Unit, New Cross Hospital, Wolverhampton, England.
Insights
Diabetic patients on hemodialysis can experience asymptomatic hypoglycemia due to glucose-free dialysis fluid. Adding glucose to dialysis fluid stabilizes blood glucose levels, preventing hypoglycemia in at-risk patients.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Disorders
Background:
- Previous reports noted asymptomatic hypoglycemia in non-diabetic patients undergoing hemodialysis.
- This study investigated hemodialysis effects on glucose and hormones in diabetic patients.
Purpose of the Study:
- To assess the impact of hemodialysis on plasma glucose, glucagon, cortisol, and catecholamines in diabetic patients.
- To identify risk factors and preventive strategies for hypoglycemia during hemodialysis in diabetics.
Main Methods:
- Eighteen diabetic patients with chronic renal failure underwent hemodialysis using glucose-free dialysis fluid.
- Blood and dialysate samples were collected during the first hour of dialysis.
- Patients were instructed not to eat during the first hour of hemodialysis.
Main Results:
- Seven of 18 patients developed hypoglycemia (plasma glucose < 4.0 mmol/l), with one reaching 2.8 mmol/l.
- No symptomatic hypoglycemia or significant hormonal changes were observed.
- Using dialysis fluid with 5.5 mmol/l glucose stabilized plasma glucose in previously hypoglycemic patients.
Conclusions:
- Hemodialysis can induce asymptomatic hypoglycemia in diabetic patients.
- Patients with initial plasma glucose ≤ 5.5 mmol/l are at higher risk, especially if on insulin or oral glucose-lowering medication.
- Dialysis fluid containing at least 5.5 mmol/l glucose is recommended for at-risk diabetic patients.
Background:
The authors have previously reported asymptomatic hypoglycemia in non-diabetic patients on hemodialysis. The present study was designed to assess the effect of hemodialysis on plasma glucose, glucagon, cortisol and catecholamines in diabetic patients.
Methods:
Eighteen diabetic patients with chronic renal failure were hemodialyzed using a glucose-free dialysis fluid. They did not take any medication prior to dialysis and were asked not to eat during the first hour on hemodialysis. Blood and dialysate were sampled at regular intervals during the first hour of dialysis for analysis.
Results:
Plasma glucose fell below 4.0 mmol/l (72 mg/dl) in 7 of the 18 patients, below 3.5 mmol/l (63 mg/dl) in 3 and below 3.0 mmol/l (54 mg/dl) in one. The lowest recorded value was 2.8 mmol/l (50 mg/dl). The mean glucose loss in the waste dialysate was 9.2 g/h. In none of the group of 7 patients whose plasma glucose fell below 4.0 mmol/l (72 mg/dl) did symptoms of hypoglycemia occur. When 6 patients from this group were subsequently dialyzed with a dialysis fluid containing 5.5 mmol/l (100 mg/dl) glucose, their plasma glucose became stabilized within the fasting reference range. There were no significant hormonal changes during the dialysis or between non-hypoglycemic and hypoglycemic patients.
Conclusions:
Patients undergoing hemodialysis may become hypoglycemic and not be aware of it. There is no hormonal imbalance causing the hypoglycemia and the hormonal response to the hypoglycemia is blunted. Patients with an initial plasma glucose of 5.5 mmol/l (100 mg/dl) or less who are hemodialyzed and who do not eat during dialysis may be particularly at risk, especially if they are on insulin or taking glucose-lowering medication. These should be dialyzed with a dialysis fluid containing at least 5.5 mmol/l (100 mg/dl) glucose.