Bushljetik Irena Rambabova, Trajceska Lada, Pusevski Vladimir, Spasovski Goce
University Department of Nephrology Skopje, North Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2019 Dec 1;40(3):41-46. doi: 10.2478/prilozi-2020-0003.
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).
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.
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).
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.
据报道，接受血液透析的糖尿病和非糖尿病患者中均出现过无症状低血糖。尿毒症症状如食欲不振、恶心和呕吐会增加透析开始时低血糖的风险。作为我们透析单元降低这种风险和失衡综合征的标准治疗方法，在无葡萄糖透析液（GFD）透析期间应用持续静脉输注5%葡萄糖溶液。在这项干预性研究中，我们试图评估标准起始透析方案与使用富含葡萄糖透析液（GRD）的新方法期间的血糖控制情况。
21例慢性肾衰竭透析患者交替使用GRD（5.6 mmol/l）和GFD透析液进行透析。他们在透析前未服用任何降糖药物，透析期间也未进食。透析期间定期采血。透析处方包括超滤量（UF）高达1 L、膜面积（MS）高达1.4平方米以及透析时间为2 - 2.5小时。患者内血糖变异性通过变异系数（CV）定义。在配对分析中，采用t检验确定每位患者两种治疗方法的血糖控制差异。对于整个组，采用t检验评估作为CV的血糖变异性。
研究参与者的平均年龄为62.95±11.73岁；7例（33%）患有糖尿病。两种透析方法在初始血压、超滤量和膜面积方面无差异。两种类型的透析中均仅发生两例低血糖事件。GRD期间的平均血糖水平分别更高（8.15±1.89对6.29±1.33，p = 0.001）。应用配对t检验时，GRD透析中的血糖CV较低，但无显著差异（16.97±8.86对21.05±11.99，p = 0.151）。仅分析糖尿病患者时，血糖CV也无显著差异（p = 0.151）。对于整个队列，无葡萄糖透析液透析中的血糖变异性显著更高（p = 0.0001）。
起始透析治疗的GRD方法不劣于标准GFD治疗。与无葡萄糖透析液相比，富含葡萄糖的透析液在透析期间能实现更好的血糖控制。
