Hemodialysis and effect of corrective measures to prevent hypoglycemia.

UNLABELLED

Type 2 diabetes mellitus is the leading cause of end stage renal disease. Chronic kidney disease (CKD) especially end stage renal disease (ESRD) usually require renal replacement therapy and are on maintenance dialysis. Glycemic control is challenging in ESRD because of uremia. Patients of ESRD commonly experience hypoglycemia during hemodialysis and these hypoglycemic episodes are most commonly seen in diabetic CKD patients. The number of hypoglycemic episodes increase mortality and morbidity in CKD patients. Hence it is important to prevent these hypoglycemic episodes during dialysis in CKD patients with diabetes.

OBJECTIVES

To study occurrence of hypoglycemia in patients of diabetic chronic kidney disease and effect of corrective measures to prevent hypoglycemia.

MATERIAL

In this study we measured Random blood sugar and dialysate sugar level before dialysis and during dialysis. This both sugar levels are measured at 30 min, 90 min and 120 min interval from start of dialysis by GOD POD method. The patients who had hypoglycemia during dialysis were provided with intradialytic carbohydrate rich snack and insulin dose reduced by 0.2-0.3 units/kg for next setting of hemodialysis.

OBSERVATION

A total of 200 diabetic CKD patients were included in the study.93(46.5%)patients developed hypoglycemia in the first setting, out of them 48 (51.61%) patients were not on any medication,33(35.48%) people on insulin, 12 (12.9%) patients on OHA. Mean blood sugar levels in patients who had hypoglycemia of the first setting was significantly low as compared to patients who did not have hypoglycemia (p value < 0.05) After corrective measures, in the second setting (n=93) of hemodialysis only 14(15%)people showed hypoglycemia out of them 07 (50%) people were not on any medication, 5 (36%) on insulin, 2 (14%) on OHA. Mean blood sugar levels of patients who had hypoglycemia in the second setting was low as compared to those without hypoglycemia but the difference was not significant. (p value > 0.05).No deaths reported during study.

CONCLUSION

1. The occurrence of hypoglycemia in diabetic CKD patients during hemodialysis is significant. 2. The corrective measures are effective in preventing hypoglycemia during hemodialysis. 3. Insulin therapy and oral hypoglycemic agents should therefore be used with caution in patients of hemodialysis.