Analysis of the influence of renal replacement therapy on the development of carbohydrate metabolism disorders and glycemia variability in patients with chronic kidney disease

BACKGROUND: Dialysis treatment is a risk factor for the development of carbohydrate metabolism disorders (CMD) and glycemia variability (VG) in patients with chronic kidney disease (CKD).

AIM: To analyse the impact of renal replacement therapy (RRT) on the development of CMD in patients with CKD without a history of diabetes mellitus (DM).

MATERIALS AND METHODS: 90 patients were examined with CKD without DM in the history (60 patients with CKD on RRT using program hemodialysis (pHD) and continuous ambulatory peritoneal dialysis (CAPD) and 30 patients with CKD 3–5 (without RRT)). Patients were collected anamnesis, measured the level of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and capillary blood glucose at 5 points in the HD and advanced CKD stages groups and at 9 points in the CAPD group. Indices of VG and dynamics of the glucose median for Friedman in all groups were evaluated. Patients with impaired fasting glycemia (IFG), impaired glucose tolerance (IGT), IGT and FPG, with first diagnosed DM were included in the CMD.

RESULTS: In the total group (n=90), the median HbA1с was 5,1 [4,9; 5,4] %, median FPG was 5,2 [4,72; 5,94] mmol/L, and median postprandial glycemia (PPG) was 6,0 [5,5; 6,8] mmol/L. 32,2% (n=29) patients of the total group had CMD: first-diagnosed DM — 2,2% (2 patients), IFG and IGT — 3,3% (3 patients), IFG — 17,8% (16 patients), IGT — 8,9% (8 patients). The prevalence of CMD in the total group was higher according to FPG and/or PPG level than according to HbA1c value (31,3% vs 10%, p<0,001). 33,3% of patients on RRT had CMD; in the group with CKD without RRT, CMD was detected in 30% of patients (p=0,025). CMD were more frequent in patients on CAPD than in patients on pHD (46,7% vs 20%, p=0,028), mainly due to IFG. Patients with CKD on pHD, compared to patients on CAPD, showed a propensity for hypoglycemia as measured by the LBGI index (0,67±0,17 vs 1,66±0,67), p<0,001.

CONCLUSION: A high prevalence of CKD was found in patients with CKD — 32,2%. Patients with CKD on RRT, compared to the group with advanced stage CKD without dialysis, have a higher incidence of CMD due to IFG and are prone to hypoglycemia development (group on pHD). A high VG within the groups was revealed regardless of the type of RRT, presence of advanced stages of CKD, day of dialysis.

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