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Glucose Levels During Dialysis with Glucose-Free Versus Glucose-Rich Dialysate Fluid
- Source :
- PRILOZI. 40:41-46
- Publication Year :
- 2019
- Publisher :
- Walter de Gruyter GmbH, 2019.
-
Abstract
- Introduction: Asymptomatic hypoglycaemia has been reported in both diabetic and non-diabetic patients on haemodialysis. Uremic symptoms as inadequate appetite, nausea and vomiting worsen the risk of hypoglycaemia at dialysis initiation. As a standard therapeutic approach for decreasing this risk and dis-equilibrium syndrome at our dialysis unit, a continuous venous 5% glucose solution is applied during the glucose-free dialysate (GFD) dialysis. In this interventional study we sought to assess the glycaemic control during standard initiating dialysis protocol versus novel approach with glucose-rich dialysis fluid (GRD). Material and methods: Twenty-one dialysis patients with chronic renal failure were dialyzed alternatively using GRD (5.6 mmol/l) and GFD fluid. They were not taking any hypoglycaemic medication prior and food during dialysis session. Blood was sampled at regular intervals during dialysis. The dialysis prescription consisted of ultrafiltration (UF) of up to 1 L, membrane surface (MS) up to 1.4 square meters and duration time of 2-2.5 hours. Intra-patient glycaemic variability was defined by Coefficient of variation (CV). In paired analysis t-test was used to determine the glucose control differences in both therapeutic approaches in each patient. For the whole group t-test was used to assess the glucose variability as CV. Results: The mean age of study participants was 62.95±11.73 years; 7 (33%) had diabetes. The two dialysis approaches did not differ in respect of initial blood pressure, UF and MS. Only two episodes of hypoglycaemia occurred in both types of dialysis. The mean glucose level was higher during GRD (8.15±1.89 vs. 6.29±1.33, p=0.001), respectively. The glucose CV was lower in GRD dialysis when pared t-test was applied, without significant difference (16.97± 8.86 vs. 21.05±11.99, p=0.151). When only diabetic patients were analysed, there was no significant glucose CV difference as well (p=0.151). For the whole cohort glucose variability was significantly higher in glucose-free dialysate dialysis (p=0.0001). Conclusion: The GRD approach for initiating dialysis sessions is non-inferior to standard GFD care. Dialysate rich in glucose obtains better glucose control during dialysis compared to glucose-free dialysate.
- Subjects :
- Blood Glucose
Male
medicine.medical_specialty
Nausea
Coefficient of variation
030232 urology & nephrology
Urology
Blood Pressure
030209 endocrinology & metabolism
Asymptomatic
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Dialysis Solutions
Diabetes mellitus
medicine
Humans
Cross-Over Studies
business.industry
General Medicine
Middle Aged
medicine.disease
Glucose
Treatment Outcome
Blood pressure
Cohort
Vomiting
Kidney Failure, Chronic
Female
medicine.symptom
Dialysis (biochemistry)
business
Biomarkers
Subjects
Details
- ISSN :
- 18578985 and 18579345
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- PRILOZI
- Accession number :
- edsair.doi.dedup.....20795d54d43f8687c1fcbf25eb0d407d