Abstract
AimsThe 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. MethodsPlasma 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). Results35 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). ConclusionsThe 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.
Highlights
Until recently the main interest in glucose during hemodialysis has been to prevent hemodialysis-induced hypoglycemia and the loss of calories when using glucose-free dialysate [1,2,3]
Complete data sets were available in 35 studies done in 14 patients with and 21 patients without type 2 diabetes mellitus (Table 1)
Patients with and without diabetes were comparable with regard to their patient characteristics and homeostatic model assessment (HOMA) indices with the exception of higher age, lower relative lean tissue mass (41.3 ± 8.8 vs. 52.6 ± 12.0%, p < 0.01), higher baseline glucose concentration, lower baseline c-peptide concentration, and larger dispersion of baseline glucose concentration in patients with diabetes
Summary
Until recently the main interest in glucose during hemodialysis has been to prevent hemodialysis-induced hypoglycemia and the loss of calories when using glucose-free dialysate [1,2,3]. Impaired glucose control is considered to play a major role in the high morbidity diabetes research and clinical practice 173 (2021) 108694 and mortality of hemodialysis patients. The extracorporeal system used in hemodialysis offers an almost unique and under-recognized access to the circulation of the patient. Solutes such as glucose can be delivered at high rates by injection into the venous line of the extracorporeal circulation. The response of the patient can be measured in the blood entering the extracorporeal circulation as well as in the dialysate outflow. Such tests can be done during regular hemodialysis
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