Study: Patients with ESKD may be at higher risk for hypoglycemia
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Key takeaways:
- Patients with advanced chronic kidney disease or end-stage kidney disease may face more frequent occurrences of hypoglycemia
- Dialysis treatment might also influence blood glucose levels.
Patients with end-stage kidney disease may be at higher risk for hypoglycemia, with a disproportionate effect on young, Black and female patients, according to published data.
“For many years, the human kidney has been considered only to play a minimal role in glucose homeostasis,” Giacomo Garibotto, MD, of the University of Genova in Italy, wrote with colleagues. Recently, “tracer-derived studies have demonstrated that this neutral kidney glucose balance is the result of a production from gluconeogenesis and simultaneous uptake. Observations that the human kidney can add glucose to circulation during respiratory or metabolic acidosis, prolonged fasting in obesity, hypoglycemia and in diabetes mellitus has clarified the role of the kidney in the regulation of glucose homeostasis and in the counter-regulatory kidney response in many stress conditions,” they wrote.
According to the researchers, dialysis may influence blood glucose levels, with peritoneal dialysis potentially leading to hypoglycemia through glucose absorption and hemodialysis resulting hypoglycemia by glucose and insulin removal.
In a nationwide retrospective study from the United States Renal Data System, researchers found a heightened risk of hypoglycemia in patients with ESKD and diabetes. Hypoglycemic crises were three times more common than hyperglycemic crises and had a disproportionate impact on vulnerable young, Black and female patient populations.
Other complications can occur in patients with ESKD as well, such as phosphorus restriction, inflammation and protein-energy wasting, Garibotto and colleagues wrote.
With a variety of risks associated with hypoglycemia, the researchers underscored the use of continuous glucose monitoring for patients with advanced kidney disease, which may help detect asymptomatic hypoglycemia and provide a picture of glucose fluctuations.
“[S]everal papers reported in this issue illustrate how the system of checks and balances that regulates body homeostasis is disrupted in patients with ESKD and offers new targets for preventive and therapeutic interventions,” they wrote. “[S]tudies reported here give strength to the concept that current practices in patients with ESKD are not ideal and prospective trials are needed to further evaluate blood optimal glucose sensing and treatment, administration techniques, and product selections in patients with diabetes and ESKD.”
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