Continuous Glucose Monitoring in Adults With Diabetes Receiving Haemodialysis: Identifying Dialysis-Specific...

To characterise continuous glucose monitoring (CGM)-derived glycaemic patterns across the dialysis cycle and to assess associations between CGM metrics, interdialytic weight gain (IDWG) as a marker of volume status, and intradialytic adverse events.

In this prospective observational study, adults with insulin-treated diabetes receiving maintenance haemodialysis underwent 2-week CGM assessment. CGM metrics were summarised for pre-dialytic, intradialytic and post-dialytic periods. Multivariable regression assessed associations between CGM metrics, HbA1c, IDWG, intradialytic hypoglycaemia and intradialytic hypotension (IDH).

In total, 40 participants (age 56.6 ± 14.7 years, 60% type 2 diabetes, diabetes duration 24.5 ± 9.9 years, HbA1c 68 ± 19 mmol/mol [8.4% ± 1.7%]) contributed 11 096 CGM glucose readings and 246 haemodialysis sessions. Time in range (TIR, 3.9-10.0 mmol/L) increased from pre-dialytic to intradialytic period (36.1% vs. 60.9%, p < 0.001) and decreased post-dialysis to 17.8% (p < 0.001). Mean glucose reduced during dialysis by 32% (from 11.1 ± 3.5 mmol/L at initiation to an intradialytic nadir of 7.6 ± 2.2 mmol/L at 125 min). Lower baseline 14-day TIR, but not HbA1c or glucose level at dialysis initiation, was independently associated with higher IDWG, which was an independent risk factor for recurrent IDH. Intradialytic hypoglycaemia (20.0% of participants) was associated with higher baseline 14-day time below range (< 3.9 mmol/L) (OR 2.42 per 1% increase, p = 0.049).

CGM identifies dialysis-specific glycaemic patterns and clinically relevant associations with IDWG and intradialytic hypoglycaemia that extend beyond HbA1c. These findings support broader evaluation of CGM in haemodialysis populations with diabetes to inform future CGM-guided strategies.