Targets and Therapeutics for Glycemic Control in Diabetes Patients on Hemodialysis

Abstract

Background: For diabetes patients without nephropathy, glycemic control is important to reduce the risk or delay the progression of diabetes complications, including nephropathy. In diabetes patients on hemodialysis, good glycemic control is necessary to improve prognosis. Many factors influence the blood glucose level of diabetes patients on hemodialysis, such as factors associated with end-stage kidney disease and factors related to hemodialysis. Therefore, since glucose metabolism in diabetes patients on hemodialysis has unique characteristics, it is necessary to manage blood glucose in these patients with specific guidelines. Here, we describe the targets and therapeutics for glycemic control in diabetes patients on hemodialysis.

Summary: According to the guidelines of the Japanese Society for Dialysis Therapy (JSDT) regarding the treatment of diabetes in hemodialysis patients, the target casual plasma glucose level (predialysis blood glucose level) is less than 180-200 mg/dL, the target glycated albumin value is less than 20.0% (less than 24.0% in patients at risk of hypoglycemia). When glycemic control is poor and the plasma glucose level before dialysis is high, hemodialysis-induced hyperglycemia may occur, in which plasma glucose decreases during hemodialysis and appears to rise after hemodialysis. On the other hand, hemodialysis patients with diabetes tend to develop hypoglycemia due to various factors. In addition, autonomic nervous system disorders may complicate the manifestation of hypoglycemia so that these patients may not exhibit symptoms. Thus, particular caution is necessary to prevent hypoglycemia. Key Messages: The plasma glucose level of hemodialysis patients with diabetes may fluctuate under the influence of many factors, such as the state of kidney function, delay in metabolism and excretion of diabetes medicine, and hemodialysis parameters. In particular, patients with poor glycemic control are susceptible to various influences, leading to a wider fluctuation in plasma glucose, with increased risk of both hyperglycemia and hypoglycemia. Since hypoglycemia may lead to a poorer prognosis and quality of life, it is necessary to control plasma glucose levels with the aim of improving the prognosis while avoiding hypoglycemia.