UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.
Ther Apher Dial. 2022 Dec;26(6):1148-1155. doi: 10.1111/1744-9987.13835. Epub 2022 Mar 27.
We wished to determine whether peri-dialytic hypoglycemia is a clinical risk in contemporary dialysis patients using glucose containing dialysate.
We measured blood glucose pre- and post-hemodialysis or hemodiafiltration, using 5.5 mmol/L glucose dialysate, and body composition by bioimpedance.
Two hundred and thirty nine patients were studied, mean age 65 ± 15.4 years, 59.4% male, 46.4% diabetes, 81.6% treated by hemodiafiltration, five hemodiafiltration patients (2.1%) had hypoglycemia, with 82 (33%) a blood glucose < 5.5 mmol/L, with fewer diabetics (19.8 vs. 74.7%, p = 0.001), and %body fat (27.7 [20.6-32.6] vs. 34.7 [26.6-42.8]%, p = 0.001). Low post-dialysis blood glucose was negatively associated with glycated hemoglobin (OR 0.94 [0.84-0.97], p = 0.004), weight (OR 0.94 [0.89-0.98], p = 0.009), and %body fat (OR 0.92 [0.86-0.98], p = 0.013).
Although hypoglycemia occurred in 2%, 33% had a blood glucose below dialysate glucose. Low post-dialysis glucose was associated with lower glycated hemoglobin and body fat, suggesting nutritional status is important in determining the risk of peri-dialytic hypoglycemia.
我们希望通过使用含有葡萄糖的透析液来确定围透析期低血糖是否是当代透析患者的临床风险。
我们使用 5.5mmol/L 葡萄糖透析液测量了 239 例患者在血液透析或血液透析滤过前后的血糖，并通过生物阻抗法测量了身体成分。
239 例患者的平均年龄为 65±15.4 岁，59.4%为男性，46.4%患有糖尿病，81.6%接受血液透析滤过治疗，5 例血液透析滤过患者（2.1%）出现低血糖，82 例（33%）血糖<5.5mmol/L，糖尿病患者较少（19.8%比 74.7%，p=0.001），体脂%（27.7[20.6-32.6]比 34.7[26.6-42.8]%，p=0.001）。低透析后血糖与糖化血红蛋白（OR 0.94[0.84-0.97]，p=0.004）、体重（OR 0.94[0.89-0.98]，p=0.009）和体脂%（OR 0.92[0.86-0.98]，p=0.013）呈负相关。
尽管低血糖的发生率为 2%，但 33%的患者血糖低于透析液葡萄糖。透析后血糖较低与糖化血红蛋白和体脂较低有关，这表明营养状况对围透析期低血糖风险的确定很重要。
