NDT Advance Access originally published online on November 5, 2007
Nephrology Dialysis Transplantation 2008 23(3):1067; doi:10.1093/ndt/gfm742
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Reply
E-mail: burmeister{at}via-rs.netSir,
We thank Dr Schneditz for his interest in our study. In his comments, the hypothesis that low blood glucose levels without symptoms could not be real, but attributable to recirculation of venous line blood in the vascular access when using glucose-free dialysate, is interesting and apposite.
Hypoglycaemia without symptoms has been previously described in diabetic patients, in circumstances other than dialysis [1] and during regular haemodialysis in diabetics and non-diabetics [2–4]; some mechanisms have been implicated in the explanation for the absence of symptoms [5–7]. This was, in fact, the motivation and the first purpose of our study: to evaluate the frequency of this phenomenon, and suggest a way to prevent it.
In our study, the possibility of recirculation in the vascular access was not directly verified, but there is some evidence against its presence: the URR of all patients enrolled in the study was regularly under 0.30 in the previous months and in the study (an indication of adequate dialysis dose, not achievable with recirculation in the vascular access); hypoglycaemia was repeatedly not observed in all blood samples of the same patient, as would be expected in the presence of significant recirculation (in this case, certainly present in the whole session of the dialysis).
Furthermore, other studies have demonstrated significant reduction of glucose levels in the blood running out of the dialyzer when using glucose-free dialysate [8], and we and others [2,3,9] found a significant loss of glucose in the dialysate leaving the dialyzer, all pointing to the possibility of a ‘real’ occurrence of systemic hypoglycaemia.
Finally, we agree that, in such a case, blood samples obtained from the peripheral circulation must be preferred, to avoid this possible kind of bias.
Conflict of interest statement. None declared.
Unidade de Medicina Renal Curso de Medicina Universidade Luterana do Brasil
References
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[Free Full Text] - Abe M, Kaizu K, Matsumoto K. Evaluation of the hemodialysis-induced changes in plasma glucose and insulin concentrations in diabetic patients: comparison between the hemodialysis and non-hemodialysis days. Ther Apher Dial (2007) 11:288–295.[CrossRef][Web of Science][Medline]
- Burmeister JE, Scapini A, da Rosa Miltersteiner D, da Costa MG, Campos BM. Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transplant (2007) 22:1184–1189.
[Abstract/Free Full Text]
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