The effect of glucose added to the dialysis fluid on blood pressure, blood glucose, and quality of life in hemodialysis patients: a placebo-controlled crossover study.
Risk for hypoglycemia increases during hemodialysis sessions. The compensatory homeostatic response to hypoglycemia may increase the risk for abnormal blood pressure regulation. The purpose is to determine blood pressure and blood glucose levels and variability in these variables during dialysis with and without glucose in the dialysis fluid. In a randomized, placebo-controlled, unblinded, crossover study of 44 hemodialysis patients, 34 patients without diabetes and 10 patients with diabetes were allocated to treatment with and without glucose in the dialysis fluid during two 10-week periods. Blood pressure and blood glucose levels were determined 5 to 8 times at each dialysis session during both periods. Quality of life was estimated by using the 36-Item Short-Form Health Survey questionnaire at the end of both treatment periods. With glucose in the dialysis fluid, blood pressure was significantly lower (systolic, 144 +/- 20 versus 149 +/- 21 mm Hg; P < 0.003; diastolic, 73 +/- 10 versus 76 +/- 10 mm Hg; P < 0.001), blood glucose level was higher (125 +/- 25 versus 110 +/- 26 mg/dL [6.96 +/- 1.36 versus 6.08 +/- 1.47 mmol/L]; P < 0.001), and quality of life was the same. Variations in systolic and diastolic blood pressures and blood glucose levels were the same during both treatments. In the subgroup of patients with diabetes, variation in blood glucose levels decreased significantly with glucose in the dialysis fluid (mean, 30 versus 37 mg/dL [1.66 versus 2.03 mmol/L]; P = 0.008). Systolic and diastolic blood pressures decreased with glucose in the dialysis fluid in patients with chronic renal failure, presumably because of insulin-induced vasodilatation in patients without diabetes. Blood glucose level regulation improved in the diabetic subgroup, and blood glucose levels were not greater in patients with diabetes with glucose in the dialysis water. Quality of life was not changed.