Hypoglycaemia episodes in older diabetic adults undergoing haemodialysis

Diabetes significantly contributes to chronic kidney disease and end-stage kidney disease. With advancing haemodialysis (HD) technology and an ageing HD population, glycaemic control has become increasingly complex. Herein, we aimed to analyse the blood glucose fluctuations and hypoglycaemia risk factors in older adults with diabetes undergoing HD.

This study included older adults with diabetes undergoing HD (April-July 2024). Continuous glucose monitoring assessed glycaemic profiles, comparing HD and non-HD days. Subgroup analyses examined all-day, dialysis-related, post-dialysis, and nocturnal hypoglycaemia.

Among 104 participants, 57 (54.8%) experienced hypoglycaemia on HD days versus 25 (24.0%) on non-HD days (P < .001). Two hours post-HD, 29 participants (27.88%) had hypoglycaemia compared with three (2.88%) (P < .001) on non-HD days. Mean blood glucose (MBG) was higher on HD days (7.59 vs. 7.45 mmol/l), with greater variability (coefficients of variation: 29.0% vs. 20.2%; standard deviation: 1.78 vs. 1.47 mmol/l; P < .001). Older age, morning dialysis, and lower MBG and BG at HD initiation increased hypoglycaemia risk during HD and within 2 h post-HD (all P < .05). Elevated MBG {odds ratio (OR) [95% confidence interval (CI)]: 0.20 (0.07, 0.58), P = .003} and BG ≥ 8.0 mmol/l at HD initiation (OR (95% CI): 0.04 (0.00, 0.34), P = .003) reduced hypoglycaemia risk during HD.

Older adults with diabetes undergoing HD exhibited significant glycaemic fluctuations and hypoglycaemia prevalence on HD days, particularly during or post-dialysis. Maintaining higher MBG and pre-HD BG may reduce hypoglycaemia. These findings underscore the need for tailored glycaemic management.