Ben-David Eyal, Hull Richard, Banerjee Debasish
Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Room G2.113, Second Floor, Grosvenor Wing, Blackshaw Road, Tooting, London SW17 0QT, UK.
Ther Adv Endocrinol Metab. 2021 Oct 5;12:20420188211048663. doi: 10.1177/20420188211048663. eCollection 2021.
Diabetes mellitus is the commonest cause of end-stage kidney failure worldwide and is a proven and significant risk factor for the development of cardiovascular disease. Renal impairment has a significant impact on the physiology of glucose homeostasis as it reduces tissue sensitivity to insulin and reduces insulin clearance. Renal replacement therapy itself affects glucose control: peritoneal dialysis may induce hyperglycaemia due to glucose-rich dialysate and haemodialysis often causes hypoglycaemia due to the relatively low concentration of glucose in the dialysate. Autonomic neuropathy which is common in chronic kidney disease (CKD) and diabetes increases the risk for asymptomatic hypoglycaemia. Pharmacological options for improving glycaemic control are limited due to alterations to drug metabolism. Impaired glucose tolerance and diabetes are also common in the post-kidney-transplant setting and increase the risk of graft failure and mortality. This review seeks to summarise the literature and tackle the intricacies of glycaemic management in patients with CKD who are either on maintenance haemodialysis or have received a kidney transplant. It outlines changes to glycaemic targets, monitoring of glycaemic control, the use of oral hypoglycaemic agents, the management of severe hyperglycaemia in dialysis and kidney transplantation patients.
糖尿病是全球终末期肾衰竭最常见的病因，也是已被证实的心血管疾病发生的重要危险因素。肾功能损害对葡萄糖稳态生理有重大影响，因为它会降低组织对胰岛素的敏感性并减少胰岛素清除率。肾脏替代治疗本身会影响血糖控制：腹膜透析可能因富含葡萄糖的透析液而诱发高血糖，而血液透析通常因透析液中葡萄糖浓度相对较低而导致低血糖。自主神经病变在慢性肾脏病（CKD）和糖尿病中很常见，会增加无症状低血糖的风险。由于药物代谢改变，改善血糖控制的药物选择有限。糖耐量受损和糖尿病在肾移植后也很常见，会增加移植失败和死亡的风险。本综述旨在总结文献并解决接受维持性血液透析或已接受肾移植的CKD患者血糖管理的复杂性。它概述了血糖目标的变化、血糖控制的监测、口服降糖药的使用、透析和肾移植患者严重高血糖的管理。
