ASSESSMENT OF GLUCOSE HOMEOSTASIS IN DIABETIC PATIENTS ON REGULAR HEMODIALYSIS (GLUCOSE CHARGED DIALYSATE) USING A CONTINOUS GLUCOSE MONITORING SYSTEM (CGMS)

Abstract

Diabetic nephropathy is the leading cause of end stage renal failure (ESRF), representing 30 – 40 % of the U.K. and U.S populations undergoing long-term maintenance hemodialysis. Diabetic patients have a high mortality rate, mainly attributed to cardiovascular disease. Although preventing diabetic kidney disease clearly is not a goal in diabetic patients with CKD stage 5 on regular hemodialysis, the main goal of treatment in these patients is to decrease the mortalities and morbidities they are exposed to including hypoglycemia. Hemodialysis utilizing conventional glucose free dialysate is accompanied by occurrence of hypoglycemia in more than 40% of these patients. Glucose charged dialysate of 100 mg/dl is FDA approved and its use versus conventional glucose free dialysate was in the scope of different studies to assess its advantages and disadvantages and whether it may reduce the incidence of hypoglycemia in dialysis patients. The continuous glucose monitoring system (CGMS) can detect unrecognized hypoglycemia and other patterns requiring insulin adjustment, not detected with intermittent blood glucose monitoring. The continuous glucose monitoring system CGMS was validated as a reliable and accurate measure of blood glucose in home use. This cross-sectional study was conducted on fifteen diabetic patients with chronic kidney disease on regular hemodialysis utilizing glucose charged dialysate, their age ranging from 45-58 years old, and five were subsequently excluded because of CGM technical failure.