title: Bicarbonate dialysis compared to hemodiafiltration on glycemic excursions in patients with end-stage renal disease with and without type 2 diabetes mellitus.
abstract: OBJECTIVE
  To evaluate the effects on glycemic excursions during bicarbonate dialysis (BHD) compared to hemodiafiltration (HDF) in type 2 diabetic or not diabetic patients affected by end-stage renal disease (ESRD).
  
  
  METHODS
  Thirty-six patients (20 affected by type 2 diabetes mellitus, and 16 not diabetic patients) were evaluated and underwent BHD dialysis, followed by HDF dialysis two days later. All patients underwent also glucose continuous monitoring system, using iPro Continuous Glucose Monitor System (Medtronic MiniMed) starting just before the BHD, and ending five days later, two days after the HDF dialysis. Glycemic control was estimated as the mean blood glucose (MBG), the area under the glucose curve above 70mg/dl (AUC>70) or 180mg/dl (AUC>180), and the percentage of time above 70mg/dl (t>70) or 180mg/dl (t>180). Intraday glycemic variability was assessed as the standard deviation (SD), M value, and the mean amplitude of glycemic excursions (MAGE). Day-to-day glycemic variability was assessed as the mean of daily difference (MODD), that is the mean of the absolute difference among glucose values taken on 2 consecutive days at the same time.
  
  
  RESULTS
  glycemic control was better with HDF: MBG, and AUC>180 were lower during HDF compared do BHD. We also observed a significant decrease of glycemic excursions during HDF dialysis: SD, M value, and the MAGE value were lower with HDF. The MODD value was significantly changed in BHD group, while no differences were recorded during HDF.
  
  
  CONCLUSIONS
  HDF seems to greater reduce glycemic excursions during the treatment compared to BHD.
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Pavia, Italy; Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy; Molecular Medicine Laboratory, University of Pavia, Pavia, Italy. Electronic address: giuseppe.derosa@unipv.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
authors.affiliation: Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Libetta
authors.affiliation: Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Esposito
authors.affiliation: Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Borettaz
authors.affiliation: Biometric Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Pavia, Italy; Molecular Medicine Laboratory, University of Pavia, Pavia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Pavia, Italy; PhD School in Experimental Medicine, University of Pavia, Pavia, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Maffioli
mesh_terms: D000368:Aged; D001639:Bicarbonates / Q000737:chemistry; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003928:Diabetic Nephropathies / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017583:Hemodiafiltration / Q000009:adverse effects*; D015312:Hemodialysis Solutions / Q000737:chemistry; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D001639:Bicarbonates; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D015312:Hemodialysis Solutions; C517652:hemoglobin A1c protein, human
keywords: Bicarbonate dialysis; Continuos glucose monitoring system; Glycemic variability; Hemodiafiltration; Type 2 diabetes mellitus