Abstract
BackgroundStudies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis.MethodA 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis.ResultsComparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 l (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12 g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively.ConclusionThe mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.
Highlights
The prevalence of chronic kidney disease (CKD) has steadily increased worldwide
Diabetes is considered the main cause of end-stage renal disease (ESRD), accounting for up to 89.7% of dialysis disease cases [1]
Some studies have already pointed to an improvement in the management of type 2 diabetes who are undergoing hemodialysis with continuous glucose monitoring (CGM) [12], but it is still not clear whether the use of CGM can improve blood glucose and control or reduce the risk of hypoglycemia [3]
Summary
The prevalence of chronic kidney disease (CKD) has steadily increased worldwide. Diabetes is considered the main cause of end-stage renal disease (ESRD), accounting for up to 89.7% of dialysis disease cases [1]. Glycemic control of chronic kidney patients on dialysis presents additional difficulties because both uremia and dialysis can affect insulin secretion and tissue insulin sensitivity In these patients, increased insulin resistance, Hissa et al Diabetol Metab Syndr (2021) 13:104 increased hepatic gluconeogenesis, impaired intracellular glucose metabolism, decreased insulin clearance and decreased insulin secretion potentiated by metabolic acidosis are observed. Patients undergoing dialysis treatment have erythrocytes with a reduced shelf life and often use erythropoiesis-stimulating agents to treat nephrogenic anemia These agents, when increasing erythropoiesis, increase the proportion of young non-glycated erythrocytes, underestimating the calculated mean glycemia [3]. Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis
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