Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis.
BACKGROUND
Hypoglycaemia (HG) has been demonstrated during chronic haemodialysis (HD). These events may become more frequent with the current use of glucose-free bicarbonate dialysis solution, the standard formula in most dialysis facilities in the last decade. On the other hand, HG-related symptoms are unusual among patients during or just after dialysis sessions. The aim of this study was to evaluate the occurrence of HG in diabetic (DM) and non-diabetic (NDM) end-stage renal failure patients during HD using dialytic solution without and with glucose.


METHODS
Forty-two chronic renal failure patients-21 DM and 21 NDM-randomly selected among the 97 in our dialysis unit were submitted to an HD session with glucose-free bicarbonate solution (phase 1). Serum glucose was measured at 30, 60, 150 and 240 min. In eight patients (four DM and four NDM) glucose was also measured in fluid leaving the dialyser at 30, 60 and 150 min. After a week, all procedures were repeated in the same patients, this time with a 90 mg/dl glucose-added bicarbonate solution (phase 2). We compared the glucose levels and the number of symptomatic and asymptomatic HG events in each group in phases 1 and 2, using bivariate analysis methods with confidence limit of 0.95%.


RESULTS
Data were expressed as mean+/-SD. No patient presented any clinical evidence of HG. For all patients, the mean plasma glucose level (mg/dl) was significantly higher in phase 2 than in phase 1 (138.2+/-96.3 vs 120.7+/-75.9; P=0.0392). This occurred in DM (171.1+/-104.5 vs 132.5+/-71.0; P=0.0067), but not in NDM (101.3+/-19.4 vs 95.2+/-21.2; P=0.06). With glucose-free HD solution, 10 patients (five DM, five NDM) presented 18 measures of glycaemia under 70 mg/dl, and with glucose-added solution, only one (DM) presented two measures under 70 mg/dl-P=0.0045 (number of patients); P=0.0003 (number of HG measures). Among DM patients, values for HG measures in phase 1 (49.1+/-16.2 mg/dl) were significantly lower than in phase 2 (65.0+/-1.4 mg/dl)-P=0.0139. For all patients, glucose was lost in HD fluid leaving the dialyser at lower values in phase 2 (5.2+/-2.9 g/h) than in phase 1 (16.7+/-10.9 g/h)-P<0.0001.


CONCLUSIONS
Asymptomatic HG was frequent during HD when glucose-free dialysis solution was used. Glucose was lost in dialytic fluid leaving the dialyser in significantly lower amounts when using glucose-added solution than glucose-free solution. Glucose-added dialysis solution at 90 mg/dl significantly reduced the number and severity of HG episodes and although it caused higher mean glycaemia in DM patients during HD, its use seems advisable in all patients.
Burmeister
Jayme Eduardo
JE
Unidade de Medicina Renal, Hospital Universitário, Universidade Luterana do Brasil, R. Alvaro Alvim, 400 90420-020, Porto Alegre, RS, Brazil. burmeister@via-rs.net
Scapini
Aline
A
da Rosa Miltersteiner
Diego
D
da Costa
Marcelo Generali
MG
Campos
Bruno Machado
BM
D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000032:analysis; D002940:Circadian Rhythm; D003928:Diabetic Nephropathies / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005947:Glucose / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D015312:Hemodialysis Solutions / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013997:Time Factors
D001639:Bicarbonates; D015312:Hemodialysis Solutions; D005947:Glucose