Glycemic Fluctuation and the Risk of Hypoglycemia Unawareness Associated with Hemodialysis in Type 2 Diabetic Renal Failure

Despite the high-risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate, presence of dialysate glucose is believed to prevent intradialytic hypoglycemia. However, exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia during HD remain unappreciated. Using continuous glucose monitoring, we evaluated glycemic excursions in 63 type 2 diabetic HD patients (44 male, HbA1c 6.4±1.2%) treated with a dialysate containing either 100, 125 or 150 mg/dL glucose. Average sensor glucose level (SGL) at start of HD after 7.2±5.0 U bolus insulin and breakfast was 187.9±56.2 mg/dL. SGL showed gradual and sustained decrease during HD irrespective of the dialysate glucose levels (Figure). SGL nadir reached below the dialysate glucose levels in 23 of 37 patients treated with dialysate containing 100 mg/dL glucose, in 14 of 17 patients with 125 mg/dL and in all 9 patients with 150 mg/dL. Fourteen of all 63 patients (22%) presented with HD-related hypoglycemia as defined by SGL <63 mg/dL during HD or immediately after HD up until the next meal. All hypoglycemic episodes revealed asymptomatic. In conclusion, type 2 diabetic HD patients present a high-risk of HD-related hypoglycemia unawareness despite the use of dialysate containing 100-150 mg/dL glucose. SGL may fall well below the dialysate glucose level toward the end of HD. Disclosure A. Hayashi: None. A. Momozono: None. S. Kawai: None. T. Masaki: None. S. Yoshino: None. A. Ogawa: None. K. Takano: None. M. Shichiri: None.