Asymptomatic Hypoglycaemia Can Be Prevented by the Addition of 5.5 mmol/L (100 mg/dL) Glucose to Dialysis Fluid in Regular Haemodialysis: A Single-Blind, Interventional Clinical Trial at a Tertiary Care Hospital

Abstract

Background:

Hypoglycemia (HG), defined as blood glucose levels below 70 mg/dL, is a recognized complication during chronic hemodialysis (HD) due to the removal of 15-30g of glucose per session. Patients with initial plasma glucose levels of 5.5 mmol/l (100 mg/dl) or lower, particularly those who do not eat during dialysis or skip meals, are at higher risk. The use of glucose-free bicarbonate dialysis solutions in most dialysis centers may exacerbate this risk.

Objective:

This study evaluates the efficacy of a dialysis fluid containing 5.5 mmol/l (100 mg/dl) glucose in preventing both hypo- and hyperglycemia in diabetic (DM) and non-diabetic (NDM) patients undergoing HD.

Methods:

Forty CRF patients (15 DM and 25 NDM) from a cohort of 50 in our dialysis unit underwent a 4-hour HD session using glucose-free bicarbonate solution (Phase 1). Plasma glucose levels were measured at the start, midpoint, and end of the session. One week later, the same patients were dialyzed using a solution containing 5.5 mmol/l (100 mg/dl) glucose (Phase 2). Glucose levels and hypoglycemic events were compared between phases.

Results:

Data is presented as mean ± SD. In Phase 1 (glucose-free dialysis), hypoglycemic events (glucose <70 mg/dl) were observed in 12 patients (30%), with significantly lower mean glucose levels compared to Phase 2. In Phase 2, no hypoglycemic events occurred in any of the 40 patients, and mean glucose levels were significantly higher (p<0.001). In DM patients, the glucose-containing dialysate did not induce hyperglycemia (glucose >200 mg/dl).

Conclusions:

Asymptomatic hypoglycemia is common during HD with glucose-free dialysis solutions but is effectively prevented by using a 5.5 mmol/l (100 mg/dl) glucose-containing dialysate. This intervention maintains stable glucose levels without inducing hyperglycemia in DM patients, supporting its routine use in HD.