Impact of long-term glycemic variability on interdialytic weight gain in diabetic hemodialysis patients

Abstract

Aims: Interdialytic weight gain (IDWG) was shown to be associated with mortality and correlated with long-term glycemic indices in diabetic hemodialysis (DHD) patients. The aim of this study was to investigate the association between glycemic variability (GV) and IDWG in DHD patients. Methods: 82 DHD patients were studied for 6 months. Six measurements of monthly predialysis glucose were used to calculate glycemic indices. The weight gain over the dry weight of the last 10 consequent hemodialysis sessions was measured for each patient to calculate IDWG. Results: IDWG was positively correlated with GV, HbA1c (p=0.025, r=0.247 and p=0.006, r=0.304, respectively) and inversely correlated with age (p=0.01, r=-0.283). GV was positively correlated with HbA1c (p<0.001, r=0.638), mean predialysis glucose (p<0.001, r=0.737) and negatively correlated with serum sodium (p=0.014, r=-271). HbA1c and age were found to be independently related to IDWG after linear regression analysis. Conclusion: GV should be taken into account to improve IDWG in DHD patients.

Keywords

• Hemodialysis
• interdialytic weight gain
• diabetes mellitus
• glycemic variability
• HbA1c

Project Number

yok.

References

1. Collins AJ, Foley RN, Chavers B, et al. US Renal Data System 2013 Annual Data Report. Am J Kidney Dis 2014; 63: A7.
2. Kalantar-Zadeh K, Kopple JD, Regidor DL,et al. A1C and survival in maintenance hemodialysis patients. Diabetes Care 2007; 30: 1049-55.
3. Zhou Z, Sun B, Huang S, Zhu C, Bian M. Glycemic variability: adverse clinical outcomes and how to improve it? Cardiovasc Diabetol 2020; 19: 102.
4. Gorst C, Kwok CS, Aslam S,et al. Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis. Diabetes Care 2015; 38: 2354-69.
5. Bancks MP, Carson AP, Lewis CE, et al. Fasting glucose variability in young adulthood and incident diabetes, cardiovascular disease and all-cause mortality. Diabetologia 2019; 62: 1366-74.
6. Echouffo-Tcheugui JB, Zhao S, Brock G, Matsouaka RA, Kline D, Joseph JJ. Visit-to-Visit Glycemic Variability and Risks of Cardiovascular Events and All-Cause Mortality: The ALLHAT Study. Diabetes Care 2019; 42: 486-93.
7. Williams ME, Garg R, Wang W, Lacson R, Maddux F, Lacson E Jr. High hemoglobin A1c levels and glycemic variability increase risk of severe hypoglycemia in diabetic hemodialysis patients. Hemodial Int 2014; 18: 423-32.
8. Shi C, Liu S, Yu HF, Han B. Glycemic variability and all-cause mortality in patients with diabetes receiving hemodialysis: A prospective cohort study. J Diabetes Complications 2020; 34: 107549.

9. Afghahi H, Nasic S, Peters B, Rydell H, Hadimeri H, Svensson J. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PLoS One 2022; 17: e0262880.
10. Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22 Suppl 2: ii45-87.
11. Stefánsson BV, Brunelli SM, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol 2014; 9: 2124-32.
12. Davenport A, Cox C, Thuraisingham R. Blood pressure control and symptomatic intradialytic hypotension in diabetic haemodialysis patients: a cross-sectional survey. Nephron Clin Pract 2008; 109: c65-71.
13. Al Maimani Y, Elias F, Al Salmi I, Aboshakra A, Allan MA, Hannawi S. Interdialytic weight gain in hemodialysis patients: worse hospital admissions and intradialytic hypotension. Open J Nephrol 2021; 11: 156-70.
14. Kimmel PL, Varela MP, Peterson RA, et al. Interdialytic weight gain and survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus. Kidney Int 2000; 57: 1141-51.
15. Dantas LGG, de Seixas Rocha M, Junior JAM, Paschoalin EL, Paschoalin SRKP, Sampaio Cruz CM. Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study. BMC Nephrol 2019; 20: 402.
16. Goto J, Forsberg U, Jonsson P, et al. Interdialytic weight gain of less than 2.5% seems to limit cardiac damage during hemodialysis. Int J Artif Organs 2021; 44: 539-50.
17. Ifudu O, Dulin AL, Friedman EA. Interdialytic weight gain correlates with glycosylated hemoglobin in diabetic hemodialysis patients. Am J Kidney Dis 1994; 23: 686-91.
18. Creme D, McCafferty K. Glycaemic Control Impact on Renal Endpoints in Diabetic Patients on Haemodialysis. Int J Nephrol 2015; 2015: 523521.
19. Davenport A. Interdialytic weight gain in diabetic haemodialysis patients and diabetic control as assessed by glycated haemoglobin. Nephron Clin Pract 2009; 113: c33-7.
20. Fang FS, Li ZB, Li CL, Tian H, Li J, Cheng XL. Influence of glycemic variability on the HbA1c level in elderly male patients with type 2 diabetes. Intern Med 2012; 51: 3109-13.
21. Yusof Khan AHK, Zakaria NF, Zainal Abidin MA, Kamaruddin NA. Prevalence of glycemic variability and factors associated with the glycemic arrays among end-stage kidney disease patients on chronic hemodialysis. Medicine (Baltimore) 2021; 100,30: e26729.
22. Topal M, Ozkan Kurtgoz P. The use of predialysis glucose as long term glycemic marker in hemodialysis patients. J Health Sci Med 2022; 5: 487-90.
23. Ipema KJ, Kuipers J, Westerhuis R, et al. Causes and Consequences of Interdialytic weight gain. Kidney Blood Press Res 2016; 41: 710-20.
24. Jalalzadeh M, Mousavinasab S, Villavicencio C, Aameish M, Chaudhari S, Baumstein D. Consequences of Interdialytic Weight Gain Among Hemodialysis Patients. Cureus 2021; 13: e15013.
25. Shamshirgaran SM, Mamaghanian A, Aliasgarzadeh A, Aiminisani N, Iranparvar-Alamdari M, Ataie J. Age differences in diabetes-related complications and glycemic control. BMC Endocr Disord 2017; 17: 25.
26. Waikar SS, Curhan GC, Brunelli SM. Mortality associated with low serum sodium concentration in maintenance hemodialysis. Am J Med 2011; 124: 77-84.
27. Sahin OZ, Asci G, Kircelli F, et al. The impact of low serum sodium level on mortality depends on glycemic control. Eur J Clin Invest 2012; 42,5: 534-40.
28. Peixoto AJ, Gowda N, Parikh CR, Santos SF. Long-term stability of serum sodium in hemodialysis patients. Blood Purif 2010; 29: 264-7.