Fischbach M, Terzic J, Bitoun Cohen C, Cousandier E, Hamel G, Battouche D, Geisert J
Children's Dialysis Unit, Hôpitaux Universitaires, Strasbourg, France.
Pediatr Nephrol. 1998 Jan;12(1):60-2. doi: 10.1007/s004670050404.
Glucose has been omitted from hemodialysates in the recent past. Currently, there is a tendency to include glucose in dialysates at physiological concentrations between 100 and 200 mg/dl (5.56-11.12 mmol/l). In adult patients, this induces, over the dialysis session, a significant uptake of glucose, with some benefits, i.e., avoidance of caloric loss, but also with some metabolic risks, i.e. decreased dialytic potassium removal secondary to an insulin-dependent intracellular potassium shift. We have performed a crossover study in five stable children (mean age 11.7 years) with normal fasting glucose on chronic bicarbonate hemodialysis. The dialysis prescription of 3-h sessions was changed only in terms of the glucose dialysate concentration, being either glucose free or containing 9.17 mmol/l (165 mg/dl) glucose; dialysates were potassium free. Twenty sessions were analyzed for each group by whole dialysate collection (glucose, potassium, phosphate) and serum concentration analysis during and post dialysis (glucose, potassium, phosphate, insulin). Glucose-free dialysis was associated with a patient net glucose loss of 113 +/- 12 mmol/session (nearly 20 g). Conversely, with the glucose-charged dialysate a small uptake of glucose was noted [13.8 +/- 2.1 mmol/session (nearly 2 g)]. At the end of the session, serum glucose was lower with the glucose-free dialysate (4.64 +/- 0.52 mmol/l) than the glucose-charged dialysate (6.11 +/- 0.92 mmol/l). Conversely, serum insulin was higher with the glucose-charged dialysate (38 +/- 17 mU/l) than the glucose-free dialysate (19 +/- 9 mU/l). There were no significant differences either for dialytic removal of potassium (70 vs. 73 mmol/session) or phosphate (20 vs. 22 mmol/session), with and without glucose dialysates. Our study, contrary to previously published data in adults, demonstrated that in children the use of a physiological concentration of glucose in the dialysate (165 mg/dl) avoids dialytic glucose loss without a significant decrease in dialytic potassium removal.
近期，葡萄糖已从血液透析液中被去除。目前，有一种趋势是在透析液中加入生理浓度（100至200毫克/分升，即5.56至11.12毫摩尔/升）的葡萄糖。在成年患者中，这会在透析过程中导致葡萄糖的大量摄取，有一些益处，即避免热量损失，但也存在一些代谢风险，即由于胰岛素依赖的细胞内钾转移导致透析时钾清除减少。我们对五名慢性碳酸氢盐血液透析的稳定儿童（平均年龄11.7岁）进行了一项交叉研究，这些儿童空腹血糖正常。3小时透析疗程的透析处方仅在葡萄糖透析液浓度方面有所改变，要么不含葡萄糖，要么含有9.17毫摩尔/升（165毫克/分升）葡萄糖；透析液不含钾。通过收集全部透析液（葡萄糖、钾、磷酸盐）以及透析期间和透析后分析血清浓度（葡萄糖、钾、磷酸盐、胰岛素），对每组的20次透析进行了分析。无葡萄糖透析与患者每次透析净葡萄糖损失113±12毫摩尔（近20克）相关。相反，使用含葡萄糖的透析液时，发现有少量葡萄糖摄取[13.8±2.1毫摩尔/次透析（近2克）]。透析结束时，无葡萄糖透析液组的血清葡萄糖（4.64±0.52毫摩尔/升）低于含葡萄糖透析液组（6.11±0.92毫摩尔/升）。相反，含葡萄糖透析液组的血清胰岛素（38±17毫国际单位/升）高于无葡萄糖透析液组（19±9毫国际单位/升）。有无葡萄糖透析液时，钾（每次透析70对73毫摩尔）或磷酸盐（每次透析20对22毫摩尔）的透析清除率均无显著差异。与先前发表的关于成人的数据相反，我们的研究表明，在儿童中，透析液中使用生理浓度的葡萄糖（165毫克/分升）可避免透析时葡萄糖损失，且不会显著降低透析时钾的清除率。
