Li Minxia, Li Yuehong, Lv Jiaxuan, Xu Huiying, Wu Xianglan, Wen Wen, Wang Wei, Yang Hua
Department of Nephrology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Changping District, Beijing, China.
Perfusion. 2023 Jan;38(1):178-185. doi: 10.1177/02676591211042726. Epub 2021 Sep 19.
To investigate the effects of glucose-free and glucose-containing dialysates during dialysis in maintenance hemodialysis (MHD) patients by the prospective cross-over study, and detect glucose control methods in MHD patients.
A total of 66 MHD 18-75 years old patients in our hospital from Nov. 2019 to Mar. 2020 were recruited. All patients underwent HD with 4 hours per time, three times per week. Glucose-free dialysate (glucose-free group) and then 5.55 mmol/L glucose-containing dialysate (glucose-5.55 group) were used alternately in dialysis. The demographics and parameters of pre- and post-dialysis were recorded.
A total of 60 patients were analyzed, and 28 patients among them had type 2 diabetes. Serum glucose pre and post dialysis were 8.64 ± 4.18 mmol/L versus 5.74 ± 1.82 mmol/L (p < 0.01) in glucose-free dialysate, and 9.31 ± 4.89 mmol/L versus 7.80 ± 2.59 mmol/L (p < 0.01) in glucose-5.55 dialysate. The post-dialysis blood glucose of glucose-free group was lower than glucose-5.55 group (5.74 ± 1.82 vs 7.80 ± 2.59, p < 0.01). About 18 (30.00%) patients in glucose-free group and 1 patient (1.67%) in glucose-5.55 group whose blood glucose was lower than 4.44 mmol/L (p < 0.01). About 29 patients (48.33%) in glucose-free group and 17 patients (28.33%; p = 0.02) in glucose-5.55 group have hunger feeling. Serum sodium level in the glucose-free group was higher than that in Glucose-5.55 group (137.92 ± 1.64 vs 136.70 ± 1.64, p < 0.01). Post-dialysis blood glucose had no significant differences between patients not using diabetes-related medication (13 patients) and patients using diabetes-related medication (15 patients) in glucose-free group (7.13 ± 1.78 mmol/L vs 6.08 ± 2.84 mmol/L, p = 0.23) and glucose-5.55 group (9.22 ± 2.59 mmol/L vs 9.35 ± 2.88 mmol/L, p = 0.90).
Glucose-free and glucose-5.55 dialysate both decrease the blood glucose post-dialysis. Dialysates containing 5.55 mmol/L glucose can reduce the incidence of hypoglycemia and lower serum sodium, but have no effect on blood pressure during dialysis. Stopping insulin and oral anti-diabetic drugs once before dialysis may not affect the control of blood glucose.
通过前瞻性交叉研究，探讨无糖和含糖透析液在维持性血液透析（MHD）患者透析过程中的效果，并检测MHD患者的血糖控制方法。
选取2019年11月至2020年3月我院66例年龄在18 - 75岁的MHD患者。所有患者每次进行4小时的血液透析，每周3次。透析时交替使用无糖透析液（无糖组）和含5.55 mmol/L葡萄糖的透析液（5.55葡萄糖组）。记录患者的人口统计学资料以及透析前后的参数。
共分析60例患者，其中28例患有2型糖尿病。无糖透析液组透析前后血糖分别为8.64±4.18 mmol/L和5.74±1.82 mmol/L（p<0.01），5.55葡萄糖透析液组分别为9.31±4.89 mmol/L和7.80±2.59 mmol/L（p<0.01）。无糖组透析后血糖低于5.55葡萄糖组（5.74±1.82 vs 7.80±2.59，p<0.01）。无糖组约18例（30.00%）患者和5.55葡萄糖组1例（1.67%）患者血糖低于4.44 mmol/L（p<0.01）。无糖组约29例（48.33%）患者和5.55葡萄糖组17例（28.33%；p = 0.02）患者有饥饿感。无糖组血清钠水平高于5.55葡萄糖组（137.92±1.64 vs 136.70±1.64，p<0.01）。在无糖组中，未使用糖尿病相关药物的患者（13例）和使用糖尿病相关药物的患者（15例）透析后血糖无显著差异（7.13±1.78 mmol/L vs 6.08±2.84 mmol/L，p = 0.23）；在5.55葡萄糖组中同样如此（9.22±2.59 mmol/L vs 9.35±
