Effect Of Hemodialysis On The Glucose Of End Stage Diabetic Nephropathy Patients And Intervention

ObjectivesTo investigated the blood glucose fluctuation of diabetic nephropathy patients (ESDN) on hemodialysis, concluded the feature of their blood glucose and related factors; prevented and reduced hypoglycemia incidence ratio of DN patients under hemodialysis, and improve quality of life.MethodsWe carried out the study by two parts. The first part, we recruited19ESDN patients, and applied CGMS to investigated their72continuous blood glucose, then compared " dialysis days" with " non dialysis days" blood sugar of ESDN patients themselves. Evaluated MBG, SDBG, AGE, MAGE, AUC, PT as index and the incidence of hypoglycemia; The second part, we took insulin dose reduced or off as an intervention to reduce ESRD patients" hypoglycemia during HD period.60patients participated in this part of study, we devided them into insulin intervention group (insulin dose halves or no, n=34) and control group (insulin dose keep no change, n=26), observed the blood glucose level on1H,2h, Oh3h,4h during HD and the incidence of hypoglycemia. At the same time, compared blood sugar loss of ESDN and NDM-ESRD(20patients each group respectively) during hemodialysis period.ResultsCGMS data were available for19subjects.The sensor glucose and finger capillary blood glucose were significantly correlated (r=0.89, P<0.001); the glucose levels on the day with dialysis have a significant fluctuation compared with the day off dialysis(P <0.05～0.01). Hemodialysis therapy make patients blood glucose significantly downward, especially during HD period.19ESDN patients had experienced15times hypoglycemia (8times in HD period,0-6am on HD day had4times, and4times at other episode), and only4times had the complains of hepoglucemic symptoms of all23times.20NDM-ESRD patients had lost glucose29.30±8.19g during their HD period, while20ESDN patients lost39.46±9.10g (P<0.01); intervention group (n=34) had a stable blood sugar during4hours of HD, compared with control group, there were no apparent diffenence at the first2hours during HD (P>0.05), however, the control group glucose decreased at the third hour and fallen down after(P<0.01). During4h HD therapy, we collected136blood sugar data from34intervention patients, only5times of3cases<3.9mmol/L(3.76%). Whereas there were14times<3.9mmol/L of7patients got from26subjects of control group(13.46%), of which5times<2.8mmol/L.ConclusionsESRD under hemodialysis patients is prone to hypoglycemia, especially ESDN patients; Application of CGMS technology can gain a fully and timely reflect dynamic changes of blood glucose, which is feasible to earlier detection and deal with low blood sugar events, especially the identification of asymptomatic hypoglycemia. As to ESDN dialysis patients, blood glucose should be "optimal" control in thire daily life, and reduce insulin dose individually on HD day, and routine testing of fingertip glucose at2.5～3.0h on dialysis, if glucose<3.9mmol/L, intravenous50%glucose solution20～40ml on time may be get more desirable results.