| Objective:To expound the blood glucose fluctuation and the occurrence of hypoglycemia during hemodialysis in diabetes mellitus(DM)and non-diabetes mellitus patients,analyze the related factors affecting the occurrence of hypoglycemia in diabetic patients,and further explore the impact of glucose-containing dialysate on the occurrence of hypoglycemia during hemodialysis,to provide reference for maintaining the stability of blood glucose during hemodialysis and reducing the occurrence of hypoglycemia.Methods:From December 2021 to December 2022,232 maintenance hemodialysis(MHD)patients in the Blood Purification Center of the Second Hospital of Jilin University were involved.These patients were divided into DM group and non-DM group according to whether they were combined with type 2 diabetes mellitus.General medical history and laboratory indicators of patients were collected,blood glucose values of patients were measured before dialysis,at 1h,2h,3h after dialysis and at the end of dialysis when using glucose-free dialysate,and indexes related to glucose variability[Stand deviation of blood glucose(SDBG),Coefficient of variation(CV),Largest amplitude of glycemic excursions(LAGE)]during hemodialysis were calculated.General medical history,laboratory indicators,blood glucose variability related indicators,and the incidence of hypoglycemia during hemodialysis were compared between the two groups.Then all diabetic patients were divided into hypoglycemia and non-hypoglycemia group according to whether hypoglycemia occurred or not,and choose multivariate logistic regression to analyze the related factors of hypoglycemia during hemodialysis.Subsequently,the dialysate was changed into glucose-containing dialysate with a glucose content of 5.5mmol/L for 4 treatments.At the fourth time of treatment with glucose-containing dialysate,the blood glucose values were measured before dialysis,at 1h,2h,3h after dialysis and at the end of dialysis,then the effects of glucose-containing dialysate on the blood glucose concentration and the occurrence hypoglycemia in diabetes and non-diabetes patients during hemodialysis were discussed.All data analyses were performed using SPSS24.0 software.Results:1.General information of enrolled patientsIn this study,232 MHD patients with an average age of 57.59±13.20 years were involved,including 128 males(55.17%)and 104 females(44.83%).Their median dialysis age was 60.50(22.50-104.75)months.Primary diseases mainly include 7categories:89 cases of chronic glomerulonephritis(38.36%),84 cases of diabetic nephropathy(36.21%),32 cases of hypertensive nephropathy(13.79%),10 cases of unknown etiology(4.31%),7 cases of polycystic kidney disease(3.02%),5 cases of interstitial nephropathy(2.16%),and 5 cases of other causes(2.16%).There were 102cases in DM group and 130 cases in non-DM group.2.Comparison of general data between DM group and non-DM groupCompared with non-DM group,the BMI of the DM group was higher(P<0.05),and the dialysis age and serum albumin value in the DM group were lower(both P<0.05).3.Comparison of blood glucose fluctuation during hemodialysis between DM group and non-DM group(1)The blood glucose values in both groups decreased gradually with the extension of hemodialysis treatment,among which the largest decrease was at the first hour of treatment,and then the decrease gradually became stable.The blood glucose fluctuation was more significant in DM group.Repeated measures analysis of variance showed statistically significant differences in the trend of blood glucose values over time between the two groups(F interaction=79.244,P<0.001).(2)SDBG,CV and LAGE in DM group were significantly greater than those of non-DM group(All P<0.001).3.Comparison of hypoglycemia during hemodialysis between DM group and non-DM groupIn the DM group,the incidence of hypoglycemia was 20.59%(21/102)and that of asymptomatic hypoglycemia was 79.17%(19/24).The incidence of hypoglycemia in the non-DM group was 4.62%(6/130),and that of asymptomatic hypoglycemia was83.33%(5/6).Hypoglycemia usually occurred from 2h to the end of dialysis.The hypoglycemia incidence of DM group was significantly higher than that of non-DM group(20.59%vs 4.62%,x~2=14.180,P<0.001).4.Analysis of factors influencing the occurrence of hypoglycemia in DM patients during hemodialysisThe single-factor results of hypoglycemia during hemodialysis showed that there were statistically significant differences between hypoglycemia and non-hypoglycemia patients in terms of reducing or stopping hypoglycemic drugs on dialysis day,the proportion of patients with pre-dialysis blood glucose level≥10mmol/L,and the course of diabetes(all P<0.05).Multivariate logistic regression analysis showed that the blood glucose level≥10mmol/L before dialysis(OR=0.185,95%CI 0.054-0.636)and hypoglycemic drug withdrawal on dialysis day(OR=0.226,95%CI 0.073-0.707)were protective factors for the occurrence of hypoglycemia during hemodialysis,and the duration of diabetes≥20 years(OR=3.280,95%CI 1.046-10.286)was a risk factor for the occurrence of hypoglycemia,with statistical significance(all P<0.05).5.Effects of glucose-containing dialysate on hypoglycemia during hemodialysis in MHD patientsCompared with glucose-free dialysate,the blood glucose levels of diabetic patients before dialysis had no difference,and the blood glucose levels at 1h,2h,3h and at the end of dialysis during the treatment with glucose-containing dialysate were significantly higher(All P<0.05).The incidence of hypoglycemia in diabetic patients treated with glucose-containing dialysate was 0.98%,which was significantly lower than that treated with glucose-free dialysate(0.98%vs 20.59%,P<0.001).Compared with glucose-free dialysate,the blood glucose levels of non-diabetic patients before dialysis had no difference,and the blood glucose levels at 1h,2h,3h and at the end of dialysis during the treatment with glucose-containing dialysate were significantly higher(All P<0.05).No one in the non-diabetic patients developed hypoglycemia during the treatment with glucose-containing dialysate.Conclusions:1.The blood glucose levels of MHD patients continued to decrease during hemodialysis.The period from 2 h to the end of dialysis is a period of high incidence of hypoglycemia,mostly asymptomatic hypoglycemia.The blood glucose fluctuation of DM patients during hemodialysis was larger than that of non-DM patients,and the incidence of hypoglycemia was higher in DM patients.2.For DM patients,the duration of diabetes≥20 years is an adverse factor for hypoglycemia during dialysis,and the reduction and withdrawal of hypoglycemic drugs on dialysis day and the blood glucose level before dialysis≥10mmol/L are protective factors for hypoglycemia during dialysis.3.Glucose-containing dialysate with a glucose content of 5.5mmol/L is beneficial to stabilize the blood glucose levels of MHD patients during hemodialysis and effectively reduce the occurrence of hypoglycemia. |
PDF Full Text Request