From the Guidelines
Dialysis can significantly affect blood glucose levels, and its impact varies depending on the type of dialysis and individual patient factors. According to the most recent study 1, achieving optimal glycemic management in people with diabetes and end-stage kidney disease (ESKD) remains a challenge. During hemodialysis, glucose is removed from the blood as it passes through the dialysis filter, which can cause blood sugar levels to drop, as noted in earlier studies 1. This effect is particularly significant for diabetic patients on dialysis, who may need adjustments to their insulin or other diabetes medications on dialysis days.
Key Considerations
- The glucose-lowering effect occurs because the dialysis solution typically contains little or no glucose, creating a concentration gradient that pulls glucose from the blood.
- Patients on dialysis who also have diabetes should monitor their blood sugar levels closely before, during, and after treatments, as they may experience hypoglycemia (low blood sugar).
- Healthcare providers often recommend reducing insulin doses on dialysis days or having a snack during treatment to prevent dangerous drops in blood sugar.
- Peritoneal dialysis can affect blood sugar differently, as the dialysis solution used in this method typically contains glucose, which can actually increase blood sugar levels as some is absorbed into the bloodstream, as explained in 1.
Recent Advances
The use of continuous glucose monitoring (CGM) systems and automated insulin delivery (AID) systems, as discussed in 1, has shown promise in managing glucose levels in patients with diabetes and advanced chronic kidney disease, including those on dialysis. These technologies provide valuable insights into an individual’s glucose patterns and allow for more personalized treatment plans, preventing impending and asymptomatic hypoglycemic and/or hyperglycemic episodes. Therefore, the use of such technologies should be considered to improve glycemic control and patient outcomes in this population.
From the Research
Effect of Dialysis on Blood Glucose Levels
- Dialysis can affect blood glucose levels in patients, particularly those with diabetes 2, 3, 4, 5.
- The use of dialysate with different glucose concentrations can impact blood glucose levels during dialysis 2, 4.
- In continuous ambulatory peritoneal dialysis (CAPD) patients, the use of a 4.25% glucose solution can cause plasma glucose levels to rise, while a 1.5% solution has a minimal effect 2.
- Hemodialysis patients with diabetes may experience a decrease in blood glucose levels during dialysis, with a higher risk of hypoglycemia 4, 5.
- Peritoneal dialysis patients may have overall increased blood glucose levels compared to hemodialysis patients 3.
Glycemic Control and Dialysis
- Glycemic control is essential for patients on peritoneal dialysis, and hemoglobin A1c (HbA1c) is commonly used to monitor blood glucose levels 6.
- However, HbA1c may be underestimated in peritoneal dialysis patients due to various factors affecting hemoglobin and glucose interaction 6.
- Studies have shown that HbA1c is associated with patient mortality in peritoneal dialysis patients, despite its limitations 6.
- Regular monitoring of blood glucose levels is crucial for hemodialysis patients with diabetes to prevent hypoglycemia 5.
- The blood glucose drop percentage can be a sensitive early warning indicator of hypoglycemia in dialysis patients 5.