Hemodialysis-induced hypoglycemia in diabetic patients

Background: The authors have previously reported asymptomatic hypoglycemia in non-diabetic patients on hemodialysis. The present study was designed to assess the effect of hemodialysis on plasma glucose, glucagon, cortisol an d catecholamines in diabetic patients. Methods: Eighteen diabetic patients with chronic renal failure were hemodialyzed using a glucose-free dialysis fluid. They did not take any medication prior to dialysis and were asked no t to eat during the first hour on hemodialysis. Blood and dialysate were sa mpled at regular intervals during the first hour of dialysis for analysis. Results: Plasma glucose fell below 4.0 mmol/l (72 mg/dl) in 7 of the 18 pat ients, below 3.5 mmol/l (63 mg/dl) in 3 and below 3.0 mmol/l (54 mg/dl) in one. The lowest recorded value was 2.8 mmol/l (50 mg/dl). The mean glucose loss in the waste dialysate was 9.2 g/h. In none of the group of 7 patients whose plasma glucose fell below 4.0 mmol/l (72 mg/dl) did symptoms of hypo glycemia occur. When 6 patients from this group were subsequently dialyzed with a dialysis fluid containing 5.5 mmol/l (100 mg/dl) glucose, their plas ma glucose became stabilized within the fasting reference range. There were no significant hormonal changes during the dialysis or between non hypogly cemic and hypoglycemic patients. Conclusions: Patients undergoing hemodialy sis may become hypoglycemic and not be aware of it. There is no hormonal im balance causing the hypoglycemia and the hormonal response to the hypoglyce mia is blunted. Patients with an initial plasma glucose of 5.5 mmol/l (100 mg/dl) or less who are hemodialyzed and who do not eat during dialysis may be particularly at risk, especially if they are on insulin or taking glucos e-lowering medication. These should be dialyzed with a dialysis fluid conta ining at least 5.5 mmol/l (100 mg/dl) glucose.