Background. The aim of this work was to study the serum glucose behavior in non-diabetic subjects treated by standard glucose-free bicarbonate hemodialysis (HD). Whilst it is known that symptomatic hypoglycemia is rare, it cannot be excluded that subclinical hypoglycemia might occur. Methods. We reviewed this issue in 22 chronic non-diabetic HD patients (mean age 68 (plus or minus) SD 8 years; m=14/f=8; average period on HD 7 (plus or minus) 5 years) treated by standard glucose-free bicarbonate HD. Eleven patients were classified as well- nourished (WN) and 11 as malnourished (MN) according to the subjective global assessment index (SGA, Nephrol Dial, Transplant 8:1094;1993). Each patient was studied twice, i.e on the same day (Monday or Tuesday) over two consecutive weeks. During the fist HD session a 200 kcal snack was provided (non-fasting dialysis, NFHD), while during the second dialysis only water was permitted (fasting HD, FHD). Results. Baseline serum glucose was similar between NFHD and FHD (85 (plus or minus) 14 mg/dL vs 87 (plus or minus) 16 mg/dL, p=ns). However, serum glucose dropped by 23 (plus or minus) 16 mg/dL during FHD and only by 8 (plus or minus) 10 mg/dL during NFHD (paired T-test p < 0.01). Blood pressure was not negatively affected by NFHD compared to FHD. Only one patient experienced discomfort immediately before the end of FHD. The drop in serum glucose was significantly associated with the baseline glucose level (r = 0.55, p < 0.01) but not with age, dialytic age, BMI and fasting insulin. During FHD, the drop in glucose levels was similar in WN and MN patients (26 (plus or minus) 18 mg/dL vs 20 (plus or minus) 13 mg/dL, p=ns). Conclusions. We conclude that during standard glucose-free HD in non-diabetic subjects, serum glucose levels decrease on average by 27%. This drop is not significantly associated with fasting insulin or nutritional status. We cannot exclude that repeated subclinical hypoglycemic episodes might have clinical implications; however, they are easily preventable by a 200 kcal snack.
Glucose-free bicarbonate hemodialysis is associated with asymptomatic hypoglycemia in non-diabetic patients
FABBIAN, Fabio;
1999
Abstract
Background. The aim of this work was to study the serum glucose behavior in non-diabetic subjects treated by standard glucose-free bicarbonate hemodialysis (HD). Whilst it is known that symptomatic hypoglycemia is rare, it cannot be excluded that subclinical hypoglycemia might occur. Methods. We reviewed this issue in 22 chronic non-diabetic HD patients (mean age 68 (plus or minus) SD 8 years; m=14/f=8; average period on HD 7 (plus or minus) 5 years) treated by standard glucose-free bicarbonate HD. Eleven patients were classified as well- nourished (WN) and 11 as malnourished (MN) according to the subjective global assessment index (SGA, Nephrol Dial, Transplant 8:1094;1993). Each patient was studied twice, i.e on the same day (Monday or Tuesday) over two consecutive weeks. During the fist HD session a 200 kcal snack was provided (non-fasting dialysis, NFHD), while during the second dialysis only water was permitted (fasting HD, FHD). Results. Baseline serum glucose was similar between NFHD and FHD (85 (plus or minus) 14 mg/dL vs 87 (plus or minus) 16 mg/dL, p=ns). However, serum glucose dropped by 23 (plus or minus) 16 mg/dL during FHD and only by 8 (plus or minus) 10 mg/dL during NFHD (paired T-test p < 0.01). Blood pressure was not negatively affected by NFHD compared to FHD. Only one patient experienced discomfort immediately before the end of FHD. The drop in serum glucose was significantly associated with the baseline glucose level (r = 0.55, p < 0.01) but not with age, dialytic age, BMI and fasting insulin. During FHD, the drop in glucose levels was similar in WN and MN patients (26 (plus or minus) 18 mg/dL vs 20 (plus or minus) 13 mg/dL, p=ns). Conclusions. We conclude that during standard glucose-free HD in non-diabetic subjects, serum glucose levels decrease on average by 27%. This drop is not significantly associated with fasting insulin or nutritional status. We cannot exclude that repeated subclinical hypoglycemic episodes might have clinical implications; however, they are easily preventable by a 200 kcal snack.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
