Introduction:
Intradialytic hypotension and hypoglycemia are common complications during hemodialysis due to the increased blood pressure and glycemic variabilities in patients with end-stage renal disease. Adding glucose into the dialysate can reduce rapid shift of fluid to prevent intradialytic hypotension with its osmotic effect as well as reduce glucose loss to prevent hypoglycemia. However, glucose degradation products can result in oxidative stress, and this concerns the use of glucose dialysate.
Methods:
A randomized controlled trial involving patients with end-stage renal disease due to diabetic kidney disease undergoing hemodialysis. Patients were randomized into interventional group (glucose dialysate 10.0 mmol/L) and control group (normal glucose-free dialysate) via block randomization, and the trends of blood pressure and glucose levels were measured during the hemodialysis. Malondialdehyde was used as a marker of reactive oxygen species.
Results:
30 patients were enrolled into this study, with 15 patients in each group of glucose and non-glucose dialysate. Majority of patients had more than a year of hemodialysis vintage (80%), hypertension (80%), and were on combination of oral antidiabetic medication and insulin (63.3%). Hemodialysis with glucose dialysate had lower blood pressure fluctuations as compared to non-glucose dialysate with changes of systolic and diastolic blood pressures within one hour of hemodialysis of -10.33±5.33 vs -23.33±9.74 (p<0.001) and -7 (8) vs -12 (14) (p=0.041) respectively. The glycemic variability was significantly lower with glucose dialysate [1.4 (0.6) vs 5.1 (4.0); p<0.001]. There was no significant difference of oxidative stress in both arms.
Table 1. Baseline characteristics of patients.
Continuous values are presented as mean ± standard deviation for normally distributed data and median (interquartile range) for non-normally distributed data. αIndependent t-test, βPearson Chi-Square.
Table 2. Outcomes of patients.
Continuous values are presented as mean ± standard deviation for normally distributed data and median (interquartile range) for non-normally distributed data. αIndependent t-test, βMann-Whitney U test.
Conclusions:
Glucose dialysate can effectively lower blood pressure and glycemic variabilities to prevent intradialytic hypotension and hypoglycemia without significant increment of oxidative stress.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.