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Hypoglycemia in Diabetic and Non-Diabetic Patients of End Stage Renal Disease on Maintenance Hemodialysis

Puneeta Gupta* , Puneeta Gupta* , Geetika Gupta** , Tejasvi Sharma*** , Rajesh Gupta**** , Anil K. Gupta*****

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Indian Journal of Emergency Medicine 2(2):p 121-128, July - December 2016. | DOI: DOI: http://dx.doi.org/10.21088/ijem.2395.311X.2216.6

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Abstract

  Clinical care of patients with end-stage renal disease (ESRD) is complex and often involves management of conditions outside of dialysis provision. Hypoglycemia is a well recognized complication of chronic kidney disease and hemodialysis, yet its prevalence among patients who are undergoing hemodialysis is subject of much debate as many of these hypoglycemic episodes may be asymptomatic. However, health effects associated with these episodes; both symptomatic and asymptomatic, can be severe, even causing sudden death of the patients. The evaluation of uremic hypoglycemia in patients of diabetes involves exclusion of obvious causes such as insulin and oral hypoglycemic therapy. Spontaneous uremic hypoglycemia in patients who do not have diabetes has been attributed to various factors like, diminished renal gluconeogenesis, poor nutrition resulting in deficiency of precursors of gluconeogenesis, impaired glycogenolysis, impaired renal insulin degradation and clearance and in a few cases, inadequate response from immediate counter-regulatory hormones such as catecholamine and glucagon. However, the mechanism(s) seems to differ from one patient to the other. And when the patients of end stage renal disease are initiated on renal replacement therapy in the form of hemodialysis , many factors related to hemodialysis itself such as of glucose-free dialysis fluid, glucose loss into the dialysate and diffusion of glucose from plasma to erythrocytes may predispose these patients to hypoglycemia. This observational prospective study was carried in the hemodialysis unit of the department of medicine, Acharya Shri Chander college of Medical Sciences and Hospital, Sidhra, Jammu. The 40 patients above 18 years of age, who were receiving maintenance hemodialysis were included in this study. The results showed progressively decreased blood glucose values in majority (80%) of the patients after the start of hemodialysis and out of 11 patients who actually developed hypoglycemia, only four patients exhibited symptoms of hypoglycemia. The aim of the study was to characterize the episodes of hypoglycemia, so that proper care is taken in anticipating, preventing and managing these episodes in future sessions of hemodialysis in this highly vulnerable group of patients .

Keywords: Hypoglycemia; Chroni

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DOI: DOI: http://dx.doi.org/10.21088/ijem.2395.311X.2216.6

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