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Niemczyk L, Schneditz D, Wojtecka A, Szamotulska K, Smoszna J, Niemczyk S. Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis. Diabetes Res Clin Pract 2021; 173:108694. [PMID: 33571598 DOI: 10.1016/j.diabres.2021.108694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 10/12/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
AIMS The disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment. METHODS Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (RHOMA) was determined by homeostatic model assessment (HOMA). RESULTS 35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as RHOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115). CONCLUSIONS The larger glucose amount recovered in dialysate in patients with increasing RHOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM.
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Affiliation(s)
- Longin Niemczyk
- Dept. of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland.
| | - Daniel Schneditz
- Otto Loewi Research Center, Div. of Physiology, Medical University of Graz, Neue Stiftingtalstrasse 6/V, 8010 Graz, Austria.
| | - Anna Wojtecka
- Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland.
| | - Katarzyna Szamotulska
- Dept. of Epidemiology and Biostatistics, National Research Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Jerzy Smoszna
- Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland.
| | - Stanisław Niemczyk
- Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland.
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Xue C, Gu YY, Cui CJ, Zhou CC, Wang XD, Ruan MN, Huang LX, Chen SX, Yang B, Chen XJ, Qian YX, Wu J, Zhao XZ, Zhang YQ, Mei CL, Zhang SL, Xu J, Mao ZG. New-onset glucose disorders in peritoneal dialysis patients: a meta-analysis and systematic review. Nephrol Dial Transplant 2019; 35:1412-1419. [PMID: 31236586 DOI: 10.1093/ndt/gfz116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/24/2019] [Indexed: 01/11/2023] Open
Abstract
Abstract
Background
Peritoneal dialysis (PD) patients are at high risk of developing glucose metabolism disturbance (GMD). The incidence and prevalence of new-onset GMD, including diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fast glucose (IFG), after initiation of PD, as well as their correlated influence factors, varies among studies in different areas and of different sample sizes. Also, the difference compared with hemodialysis (HD) remained unclear. Thus we designed this meta-analysis and systematic review to provide a full landscape of the occurrence of glucose disorders in PD patients.
Methods
We searched the MEDLINE, Embase, Web of Science and Cochrane Library databases for relevant studies through September 2018. Meta-analysis was performed on outcomes using random effects models with subgroup analysis and sensitivity analysis.
Results
We identified 1124 records and included 9 studies involving 13 879 PD patients. The pooled incidence of new-onset DM (NODM) was 8% [95% confidence interval (CI) 4–12; I2 = 98%] adjusted by sample sizes in PD patients. Pooled incidence rates of new-onset IGT and IFG were 15% (95% CI 3–31; I2 = 97%) and 32% (95% CI 27–37), respectively. There was no significant difference in NODM risk between PD and HD [risk ratio 0.99 (95% CI 0.69–1.40); P = 0.94; I2 = 92%]. PD patients with NODM were associated with an increased risk of mortality [hazard ratio 1.06 (95% CI 1.01–1.44); P < 0.001; I2 = 92.5%] compared with non-DM PD patients.
Conclusions
Around half of PD patients may develop a glucose disorder, which can affect the prognosis by significantly increasing mortality. The incidence did not differ among different ethnicities or between PD and HD. The risk factor analysis did not draw a definitive conclusion. The glucose tolerance test should be routinely performed in PD patients.
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Affiliation(s)
- Cheng Xue
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yan-Yan Gu
- Department of Nutrition, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Cheng-Ji Cui
- Department of Nephrology, First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Chen-Chen Zhou
- Department of Nephrology, Yueyang Hospital, Shanghai, China
| | - Xian-Dong Wang
- Department of Internal Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Meng-Na Ruan
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lin-Xi Huang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Si-Xiu Chen
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xu-Jiao Chen
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi-Xin Qian
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xue-Zhi Zhao
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu-Qiang Zhang
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Lin Mei
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shou-Lin Zhang
- Department of Nephrology, First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jing Xu
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Guo Mao
- Department of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Simic-Ogrizovic S, Backus G, Mayer A, Vienken J, Djukanovic L, Kleophas W. The Influence of Different Glucose Concentrations in Haemodialysis Solutions on Metabolism and Blood Pressure Stability in Diabetic Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139880102401210] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years the percentage of diabetic patients on haemodialysis has increased. Considering the high frequency of intradialytic hypotensive and hypoglycaemic episodes experienced by these patients, it was the aim of the present study to evaluate the influence of different dialysate glucose concentrations (5.5 mmol/L or 11 mmol/L) on blood pressure and glycaemic regulation, using special dialysis equipment - the GENIUS® System. This cross-over, prospective and randomised study, total duration 14 weeks, included 20 diabetic patients on maintenance haemodialysis. Group 1: 9 patients dialysed using dialysate with a glucose concentration of 5.5 mmol/L and after 7 weeks switched to dialysate with a glucose concentration of 11 mmol/L. Group 2: vice versa. Results show a statistically higher number of patients with hypoglycaemic and hypotensive episodes using dialysate with a 5.5 mmol/L glucose concentration. Also, mean serum glucose values were higher during haemodialysis sessions with a glucose dialysate concentration of 11 mmol/L. There were no statistical differences between the groups in laboratory values, HbA1C, insulin doses or in anthropometric parameters. Our results suggest that fewer diabetic patients undergoing haemodialysis using a higher dialysate glucose concentration of 11 mmol/L have hypoglycaemic and hypotensive episodes. Since this dialysate glucose concentration had no influence on lipid or hepatic metabolism, anthropometric parameters and especially HbA1C values in this short-term study, the long term examination of its effects is warranted.
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Affiliation(s)
| | | | - A. Mayer
- Fresenius Medical Care, Bad Homburg - Germany
| | - J. Vienken
- Fresenius Medical Care, Bad Homburg - Germany
| | - L. Djukanovic
- Clinic of Nephrology, Clinical Center of Serbia, Belgrade - Yugoslavia
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Tian JH, Ma B, Yang K, Liu Y, Tan J, Liu TX. Bicarbonate- versus lactate-buffered solutions for acute continuous haemodiafiltration or haemofiltration. Cochrane Database Syst Rev 2015; 2015:CD006819. [PMID: 25740673 PMCID: PMC10590204 DOI: 10.1002/14651858.cd006819.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a severe loss of kidney function that results in patients' inability to appropriately excrete nitrogenous wastes and creatinine. Continuous haemodiafiltration (HDF) or haemofiltration (HF) are commonly used renal replacement therapies for people with AKI. Buffered dialysates and solutions used in HDF or HF have varying effects on acid-base physiology and several electrolytes. The benefits and harms of bicarbonate- versus lactate-buffered HDF or HF solutions for treating patients with AKI remain unclear. OBJECTIVES To assess the benefits and harms of bicarbonate- versus lactate-buffered solutions for HDF or HF for treating people with AKI. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register to 6 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched the Chinese Biomedical Literature Database. SELECTION CRITERIA All randomised controlled trials (RCT) and quasi-RCTs that reported comparisons of bicarbonate-buffered solutions with lactate-buffered solutions for AKI were selected for inclusion irrespective of publication status or language. DATA COLLECTION AND ANALYSIS Two authors independently assessed titles and abstracts, and where necessary the full text of studies, to determine which satisfied our inclusion criteria. Data were extracted by two authors who independently assessed studies for eligibility and quality using a standardised data extraction form. Methodological quality was assessed using the Cochrane risk of bias tool. Results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS We identified four studies (171 patients) that met our inclusion criteria. Overall, study quality was suboptimal. There were significant reporting omissions related to methodological issues and potential harms. Outcome measures were not defined or reported adequately. The studies were small and lacked follow-up phases.Serum lactate levels were significantly lower in patients treated with bicarbonate-buffered solutions (4 studies, 171 participants: MD -1.09 mmol/L, 95% CI -1.30 to -0.87; I(2) = 0%). There were no differences in mortality (3 studies, 163 participants: RR 0.76, 95% CI 0.50 to 1.15; I(2) = 0%); serum bicarbonate levels (3 studies, 163 participants: MD 0.27 mmol/L, 95% CI -1.45 to 1.99; I(2) = 78%), serum creatinine (2 studies, 137 participants: MD -22.81 µmol/L, 95% CI -129.61 to 83.99; I(2) = 73%), serum base excess (3 studies, 145 participants: MD 0.80, 95% CI -0.91 to 2.50; I(2) = 38%), serum pH (4 studies, 171 participants: MD 0.01, 95% CI -0.02 to 0.03; I(2) = 70%) or carbon dioxide partial pressure (3 studies, 151 participants: MD -1.04, 95% CI -3.84 to 1.76; I(2) = 83%). A single study reported fewer cardiovascular events (RR 0.39, 95% CI 0.20 to 0.79), higher mean arterial pressure (10.25 mm Hg, 95% CI 6.68 to 13.82) and less hypotensive events (RR 0.44, 95% CI 0.26 to 0.75) in patients receiving bicarbonate-buffered solutions. One study reported no significant difference in central venous pressure (MD 2.00 cm H2O, 95% CI -0.7 to, 4.77). Total length of hospital and ICU stay and relapse were not reported by any of the included studies. AUTHORS' CONCLUSIONS There were no significant different between bicarbonate- and lactate-buffered solutions for mortality, serum bicarbonate levels, serum creatinine, serum base excess, serum pH, carbon dioxide partial pressure, central venous pressure and serum electrolytes. Patients treated with bicarbonate-buffered solutions may experience fewer cardiovascular events, lower serum lactate levels, higher mean arterial pressure and less hypotensive events. With the exception of mortality, we were not able to assess the main primary outcomes of this review - length of time in ICU, total length of hospital stay and relapse.
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Affiliation(s)
- Jin Hui Tian
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Bin Ma
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - KeHu Yang
- Lanzhou UniversityKey Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu ProvinceNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Yali Liu
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Jiying Tan
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Tian Xi Liu
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
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Clearance, Distribution Volume, and Dialyzer Mass Area Transport Coefficient of Glucose in Whole Blood. ASAIO J 2012; 58:137-42. [DOI: 10.1097/mat.0b013e3182452b57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schneditz D, Hafner-Giessauf H, Holzer H, Thomaseth K. Intracorporeal Glucose Disposal During Hemodialysis After a Standardized Glucose Load. ASAIO J 2010; 56:204-9. [DOI: 10.1097/mat.0b013e3181ce1c9b] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE OF REVIEW Intradialytic nutritional support has been used for more than 30 years both in critically ill patients with acute renal failure and during maintenance hemodialysis. Present knowledge allows better estimation of its metabolic and nutritional efficacy, as well its effect on patient outcome. RECENT FINDINGS Recent data showed that intradialytic nutritional support is able to counteract these effects of dialysis on protein metabolism and to improve both nitrogen and energy balance. In maintenance hemodialysis patients, the improvement of nutritional status during nutritional support was shown to improve long-term survival. In critically ill patients with acute renal failure, protein sparing is one of the main therapeutic goals. The effect of nutritional support on patient outcome is not demonstrated. Recent data, however, showed that the improvement of nitrogen balance may be associated with a better outcome. SUMMARY Current information helps to better assess the effects of intradialytic nutritional support, to clarify the nutritional management of renal failure patients and to provide recommendations. Future research should focus on the possible means to improve the efficacy of nutritional support, either by modifying its components of by associating anabolic or anticatabolic agents.
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Affiliation(s)
- Noël J M Cano
- CRNH Auvergne, CHU Clermont-Ferrand, G Montpied Hospital, Clermont1 University, Clermont-Ferrand, France.
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Smith GI, Jeukendrup AE, Ball D. Sodium acetate induces a metabolic alkalosis but not the increase in fatty acid oxidation observed following bicarbonate ingestion in humans. J Nutr 2007; 137:1750-6. [PMID: 17585026 DOI: 10.1093/jn/137.7.1750] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We conducted this study to quantify the oxidation of exogenous acetate and to determine the effect of increased acetate availability upon fat and carbohydrate utilization in humans at rest. Eight healthy volunteers (6 males and 2 females) completed 2 separate trials, 7 d apart in a single-blind, randomized, crossover design. On each occasion, respiratory gas and arterialized venous blood samples were taken before and during 180 min following consumption of a drink containing either sodium acetate (NaAc) or NaHCO3 at a dose of 2 mmol/kg body mass. Labeled [1,2 -13C] NaAc was added to the NaAc drink to quantify acetate oxidation. Both sodium salts induced a mild metabolic alkalosis and increased energy expenditure (P < 0.05) to a similar magnitude. NaHCO3 ingestion increased fat utilization from 587 +/- 83 kJ/180 min to 693 +/- 101 kJ/180 min (P = 0.01) with no change in carbohydrate utilization. Following ingestion of NaAc, the amount of fat and carbohydrate utilized did not differ from the preingestion values. However, oxidation of the exogenous acetate almost entirely (90%) replaced the additional fat that had been oxidized during the bicarbonate trial. We determined that 80.1 +/- 2.3% of an exogenous source of acetate is oxidized in humans at rest. Whereas NaHCO3 ingestion increased fat oxidation, a similar response did not occur following NaAc ingestion despite the fact both sodium salts induced a similar increase in energy expenditure and shift in acid-base balance.
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Affiliation(s)
- Gordon I Smith
- School of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, Scotland
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Sangill M, Pedersen EB. The effect of glucose added to the dialysis fluid on blood pressure, blood glucose, and quality of life in hemodialysis patients: a placebo-controlled crossover study. Am J Kidney Dis 2006; 47:636-43. [PMID: 16564941 DOI: 10.1053/j.ajkd.2006.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 01/10/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Risk for hypoglycemia increases during hemodialysis sessions. The compensatory homeostatic response to hypoglycemia may increase the risk for abnormal blood pressure regulation. The purpose is to determine blood pressure and blood glucose levels and variability in these variables during dialysis with and without glucose in the dialysis fluid. METHODS In a randomized, placebo-controlled, unblinded, crossover study of 44 hemodialysis patients, 34 patients without diabetes and 10 patients with diabetes were allocated to treatment with and without glucose in the dialysis fluid during two 10-week periods. Blood pressure and blood glucose levels were determined 5 to 8 times at each dialysis session during both periods. Quality of life was estimated by using the 36-Item Short-Form Health Survey questionnaire at the end of both treatment periods. RESULTS With glucose in the dialysis fluid, blood pressure was significantly lower (systolic, 144 +/- 20 versus 149 +/- 21 mm Hg; P < 0.003; diastolic, 73 +/- 10 versus 76 +/- 10 mm Hg; P < 0.001), blood glucose level was higher (125 +/- 25 versus 110 +/- 26 mg/dL [6.96 +/- 1.36 versus 6.08 +/- 1.47 mmol/L]; P < 0.001), and quality of life was the same. Variations in systolic and diastolic blood pressures and blood glucose levels were the same during both treatments. In the subgroup of patients with diabetes, variation in blood glucose levels decreased significantly with glucose in the dialysis fluid (mean, 30 versus 37 mg/dL [1.66 versus 2.03 mmol/L]; P = 0.008). CONCLUSION Systolic and diastolic blood pressures decreased with glucose in the dialysis fluid in patients with chronic renal failure, presumably because of insulin-induced vasodilatation in patients without diabetes. Blood glucose level regulation improved in the diabetic subgroup, and blood glucose levels were not greater in patients with diabetes with glucose in the dialysis water. Quality of life was not changed.
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Affiliation(s)
- Maren Sangill
- Department of Medical Research, Holstebro Hospital, Aarhus University, Holstebro, Denmark
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