Approach Towards Hypoglycemia During Hemodialysis: Reactive Treatment to Proactive Prevention

Introduction: Patients undergoing haemodialysis are at risk of hypoglycaemia which is associated with poor outcomes, including mortality. The reasons includes decreased gluconeogenesis in the remnant kidneys, inadequate nutrition, decreased insulin clearance and glucose loss to the dialysate. Objectives: Haemodialysis-induced hypoglycaemia is common during treatments with glucose-free dialysate. The primary objective was to compare the use of glucose containing dialysate and glucose free dialysate to reduce hypoglycaemic events in patients undergoing haemodialysis. Methods: A comparative study was conducted using glucose containing dialysate and glucose free dialysates solution in Haemodialysis patients with frequent hypoglycaemia using the Quantitative Quasi Experimental design. Among the 150 patients undergoing haemodialysis in outpatient department, 88 patients were selected for the study who had frequent episodes of hypoglycaemia. Occurrence of hypoglycaemia event during pre-dialysis, intra-dialysis and post-dialysis were analyzed in both the groups. Other parameters that were assessed included dietary habits before coming to dialysis, reviewing insulin dosage with nephrologist/endocrinologist and presence of diabetes status. The results were tabulated and statistical analysis was performed. Results: Number of hypoglycaemia events reduced from September 2021- 6.63% (132) to May 2023- 1.89% (43). The calculated t value of blood glucose level during Intra dialysis (after 2 hrs) is 4.05 and post haemodialysis is 3.56 which is greater than table value of 1.98 which shows that the use of glucose containing dialysate solution is effective in reducing the hypoglycaemic events in haemodialysis patients who are prone to hypoglycaemia during dialysis. Conclusion: The use of 5.58 mmol/l glucose containing dialysate during haemodialysis, changing patients eating habits and modifying anti-hyperglycaemic agents helped in reducing the hypoglycaemic events during haemodialysis. Appropriate glycaemic control tailored for patients on haemodialysis is needed to avoid haemodialysis-induced hypoglycaemia.