Peri‐dialytic hypoglycemia with hemodialysis and online post‐dilutional hemodiafiltration

We wished to determine whether peri-dialytic hypoglycemia is a clinical risk in contemporary dialysis patients using glucose containing dialysate.We measured blood glucose pre- and post-hemodialysis or hemodiafiltration, using 5.5 mmol/L glucose dialysate, and body composition by bioimpedance.Two hundred and thirty nine patients were studied, mean age 65 ± 15.4 years, 59.4% male, 46.4% diabetes, 81.6% treated by hemodiafiltration, five hemodiafiltration patients (2.1%) had hypoglycemia, with 82 (33%) a blood glucose < 5.5 mmol/L, with fewer diabetics (19.8 vs. 74.7%, p = 0.001), and %body fat (27.7 [20.6-32.6] vs. 34.7 [26.6-42.8]%, p = 0.001). Low post-dialysis blood glucose was negatively associated with glycated hemoglobin (OR 0.94 [0.84-0.97], p = 0.004), weight (OR 0.94 [0.89-0.98], p = 0.009), and %body fat (OR 0.92 [0.86-0.98], p = 0.013).Although hypoglycemia occurred in 2%, 33% had a blood glucose below dialysate glucose. Low post-dialysis glucose was associated with lower glycated hemoglobin and body fat, suggesting nutritional status is important in determining the risk of peri-dialytic hypoglycemia.