The effect of continuous glucose injection on preventing hypoglycemia during hemodialysis

Kim, Sung Kwon; Lee, Jong Min; Kim, Hye Soo; Shin, Young Shin; Kim, Young Ok; Yoon, Sun Ae; Park, Cheol Whee; Kim, Suk Young; Bang, Byung Kee

Abstract

BACKGROUND: Hypoglycemic episodes in patients under hemodialysis have been known to be caused by the removal of glucose through dialyzer membrane and is one of the important factors causing discomfort, especially in patients with diabetes. We studied frequency of hypoglycemia, characteristics of patients and their underlying disease and changes of glucagon and cortisol levels during dialysis. We also studied whether continuous glucose injection could prevent hypoglycemic episodes during dialysis with dialysate lacking glucose.
METHODS
Forty-four patients under hemodialysis treatment were enrolled. All patients were observed for 5 sessions of dialysis before enrolled in glucose injection therapy. Their blood were collected at time 0, 2 and 4 hours after starting final session of dialysis. After one month, blood samples were collected at the same time interval during dialysis with continuous glucose injection (50% glucose solution, 12.5 g/h).
RESULTS
Twenty-two patients (DM 12 patients, non-DM 10 patients) showed their blood glucose level less than 60 mg/dL during dialysis. Among these patients, 3 patients did not complain any hypoglycemic symptoms. No patient showed hypoglycemia under continuous glucose injection during dialysis. Frequency of random glucose injection according to patients' complaint was significantly decreased during continuous glucose injection. Urea reduction rate was not affected by glucose injection. There was no significant difference in patients' characteristics and their underlying diseases, basal and amount of changes of glucagon and cortisol concentration during dialysis regardless episode of hypoglycemia.
CONCLUSION
Hypoglycemic episode during hemodialysis occurs as frequently in non-diabetic patients as in diabetic patients. Continuous glucose injection could be an effective and convenient method to prevent hypoglycemia during hemodialysis in both diabetic and non-diabetic patients.