GLYCEMIC VARIABILITY IN DIABETIC PATIENTS ON CHRONIC HEMODIALYSIS: IMPORTANCE AND MONITORING METHODS

  • Andra Elena Balcangiu-Stroescu Department of Dialysis, Bucharest Emergency University Hospital, Bucharest, Romania & Discipline of Physiology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Delia Timofte Department of Dialysis, Bucharest Emergency University Hospital, Bucharest, Romania
  • Dorin Dragoș Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Internal Medicine I, Bucharest Emergency University Hospital, Bucharest, Romania
  • Maria Daniela Tănăsescu Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Nephrology, Bucharest Emergency University Hospital, Bucharest, Romania
  • Iuliana Ghenu Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Internal Medicine I, Bucharest Emergency University Hospital, Bucharest, Romania
  • Ileana Adela Văcăroiu Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, Bucharest, Romania
  • Adrian Tulin Department of Anatomy, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of General Surgery, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania
  • Ovidiu Știru Department of Cardiovascular Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Cardiovascular Surgery “Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases Bucharest, Romania
  • Doina Andrada Mihai Department of Diabetes, Nutrition and Metabolic Disease, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Dorin Ionescu Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department of Nephrology, Bucharest Emergency University Hospital, Bucharest, Romania
  • Anca Oprescu Macovei Department of Gastroenterology, “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania
  • Raluca Tulin Department of Embryology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Cornelia Nitipir Department of Oncology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Keywords: hemodialysis, diabetes, glucose variation

Abstract

Diabetes mellitus (DM) is associated with increased risk of chronic kidney disease (CKD). Several factors may increase the risk of hypoglycemia in diabetic patients with end-stage renal disease (ESRD). Increased glycemic variability in diabetic patients on chronic hemodialysis augments death risk; consequently, glucose monitoring may improve the prognostic of these patients. Carefully selected continuous glycemic monitoring devices may allow better monitoring, which is expected to translate into better treatment tailoring, from which diabetic patients on chronic hemodialysis may consistently benefit in terms of outcome, improved quality of life, and lower death risk.

References

[1] R.T. Gansevoort et al. Too much nephrology? The CKD epidemic is real and concerning. A PRO view. Nephrol Dial Transplant. Vol. 34 pp 577-580, April 2019.
[2] M. Liu, X.C. Li, L. Lu, Y. Cao, R.R. Sun, S. Chen, P.Y. Zhang. Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci. vol. 10, pp 2918-26, June 2014.
[3] L. Ma, S. Zhao. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. Int J Cardiol. vol. 238, pp 151-158, July 2017.
[4] H. J. Anders, T.B. Huber, B. Isermann, M. Schiffer. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol, vol 14, pp 361-377, June 2018.
[5] K.R. Tuttle, G.L. Bakris, R.W. Bilous, J.L Chiang, I.H. de Boer, J. Goldstein-Fuchs, I.B. Hirsch, K. Kalantar-Zadeh, A.S. Narva, S.D. Navaneethan, J.J. Neumiller, U.D. Patel, R.E. Ratner, A.M. Whaley-Connell, M.E. Molitch. Diabetic kidney disease: a report from an ADA Consensus Conference. Am J Kidney Dis. Vol 64, pp 510-33, Octomber 2019.
[6] V. Garla, S. Kanduri, L. Yanes-Cardozo, L.F. Lién. Management of diabetes mellitus in chronic kidney disease. Minerva Endocrinol. Vol 44, pp 273-287, September 2019.
[7] C.H. Sampanis. Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure. Hippokratia. Vol 12, pp 22-27, July 2008.
[8] R.J. Galindo, R.W. Beck, M.F. Scioscia, G.E. Umpierrez, K.R. Tuttle. Glucose monitoring and Management in Advanced Chronic Kidney Disease. Endocr Rev. vol 41, pp 756–74, Octomber 2020.
[9] M.A. Jackson, M.R. Holland, J. Nicholas, et al. Hemodialysis-induced hypoglycemia in diabetic patients. Clinical Nephrology. Vol 54, pp 30-34, July 2000.
[10] V. Papademetriou, L. Lovato, M. Doumas, E. Nylen, A. Mottl, R.M. Cohen; ACCORD Study Group. Chronic kidney disease and intensive glycemic control increase cardiovascular risk in patients with type 2 diabetes. Kidney Int. Vol 87, pp 649-59, March 2015.
[11] P. Gupta, R. Gupta, A.K. Gupta. Glycemic Control in Patients with Diabetic Kidney Disease; Time to Recognize Perils of Iatrogenic Hypoglycemia? Moving away from Intensive Glycemic Control. J Assoc Physicians India. Vol 66, pp70-75, September 2015.
[12] Z. Zhou, B. Sun, S. Huang , C. Zhu. Glycemic variability: adverse clinical outcomes and how to improve it? Cardiovasc Diabetol. Vol 19, pp 102, July 2020.
[13] C. Shi, S. Liu, H.F. Yu, B. Han. Glycemic variability and all-cause mortality in patients with diabetes receiving hemodialysis: A prospective cohort study. J Diabetes Complications. Vol 34, pp 117-120, April 2020.
[14] American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes-2021. Diabetes Care. Vol 44, pp S73-S84, January 2021.
[15] T. Bomholt , T. Adrian, K. Nørgaard, A.G. Ranjan , T. Almdal, A. Larsson A. The Use of HbA1c, Glycated Albumin and Continuous Glucose Monitoring to Assess Glucose Control in the Chronic Kidney Disease Population Including Dialysis. Nephron. Vol 145 pp14-19, March 2021.
[16] Z. Bloomgarden, Y. Handelsman. How does CKD affect HbA1c? J Diabetes.Vol 10, pp 270, April 2018.
[17] S. Copur, D. Siriopol, B. Afsar, M.C. Comert, G. Uzunkopru et al. Serum glycated albumin predicts all-cause mortality in dialysis patients with diabetes mellitus: meta-analysis and systematic review of a predictive biomarker. Acta Diabetol. Vol 58, pp 81-91, January 2021.
[18] American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2021. Diabetes Care. Vol 44, pp: S85-S99, January 2021.
Published
2021-07-31
How to Cite
Balcangiu-Stroescu, A., Timofte, D., Dragoș, D., Tănăsescu, M., Ghenu, I., Văcăroiu, I., Tulin, A., Știru, O., Mihai, D., Ionescu, D., Oprescu Macovei, A., Tulin, R., & Nitipir, C. (2021). GLYCEMIC VARIABILITY IN DIABETIC PATIENTS ON CHRONIC HEMODIALYSIS: IMPORTANCE AND MONITORING METHODS. Romanian Journal of Clinical Research, 4(1). Retrieved from http://rjcronline.com/index.php/rjcr/article/view/72