Evaluation and management of diabetic and non-diabetic hypoglycemia in end-stage renal disease

Aidar R. Gosmanov, Elvira O. Gosmanova, Csaba Kovesdy

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Patients with end-stage renal disease (ESRD) regardless of diabetes status are at increased risk of hypoglycemia with a resultant array of adverse clinical outcomes. Therefore, hypoglycemia should be thoroughly evaluated in ESRD patients. In diabetic dialysis patients, hypoglycemic agents and nutritional alterations can trigger hypoglycemia in the background of diminished gluconeogenesis, reduced insulin clearance by the kidney and improved insulin sensitivity following initiation of renal replacement therapy. Detailed evaluation of antidiabetic regimen and nutritional patterns, patient education on self-monitoring of blood glucose and/or referral to a diabetes specialist may reduce risk of subsequent hypoglycemia. In certain situations, it is important to recognize the possibility of non-diabetic causes of hypoglycemia in patients with diabetes and to avoid treating pseudo-hyperglycemia caused by glucose- non-specific glucometers in patients utilizing icodextrin-based solutions for peritoneal dialysis. Adrenal insufficiency, certain medications, malnutrition and/or infection are among the most common causes of hypoglycemia in non-diabetic ESRD patients, and they should be suspected after exclusion of inadvertent use of hypoglycemic agents. The goal of this review article is to summarize approaches and recommendations for the work up and treatment of hypoglycemia in ESRD.

Original languageEnglish (US)
Pages (from-to)8-15
Number of pages8
JournalNephrology Dialysis Transplantation
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2016

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Hypoglycemia
Chronic Kidney Failure
Hypoglycemic Agents
Blood Glucose Self-Monitoring
Adrenal Insufficiency
Renal Replacement Therapy
Gluconeogenesis
Proxy
Peritoneal Dialysis
Patient Education
Malnutrition
Hyperglycemia
Insulin Resistance
Dialysis
Referral and Consultation
Insulin
Kidney
Glucose
Infection

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Evaluation and management of diabetic and non-diabetic hypoglycemia in end-stage renal disease. / Gosmanov, Aidar R.; Gosmanova, Elvira O.; Kovesdy, Csaba.

In: Nephrology Dialysis Transplantation, Vol. 31, No. 1, 01.01.2016, p. 8-15.

Research output: Contribution to journalReview article

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