الفهرس 
Glucose homeostasisOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Diabetic nephropathy is the leading cause of end stage renal
failure (ESRF), representing 30 – 40 % of the U.K. and U.S populations
undergoing long-term maintenance hemodialysis.
Diabetic patients have a high mortality rate, mainly attributed to
cardiovascular disease.
Although preventing diabetic kidney disease clearly is not a goal
in diabetic patients with CKD stage 5 on regular hemodialysis, the main
goal of treatment in these patients is to decrease the mortalities and
morbidities they are exposed to including hypoglycemia.
Hemodialysis utilizing conventional glucose free dialysate is
accompanied by occurrence of hypoglycemia in more than 40% of these
patients.
Glucose charged dialysate of 100 mg/dl is FDA approved and its
use versus conventional glucose free dialysate was in the scope of
different studies to assess its advantages and disadvantages and whether it
may reduce the incidence of hypoglycemia in dialysis patients.
The continuous glucose monitoring system (CGMS) can detect
unrecognized hypoglycemia and other patterns requiring insulin
adjustment, not detected with intermittent blood glucose monitoring.
The continuous glucose monitoring system CGMS was validated
as a reliable and accurate measure of blood glucose in home use.
This cross-sectional study was conducted on fifteen diabetic
patients with chronic kidney disease on regular hemodialysis utilizing
glucose charged dialysate, their age ranging from 45-58 years old, and
five were subsequently excluded because of CGM technical failure.
Aim of the study:
1. To evaluate glycemic state in diabetic patients with chronic kidney
disease on regular hemodialysis dialyzed against a glucose charged
dialysate of 100 mg/dl using a continuous glucose monitoring
system (CGMS).
2. Comparison of glycemic state in relation to dialysis against a
glucose charged dialysate as follow:
o Day off dialysis before (day 1).
o Day on dialysis (day 2).
o Day off dialysis after (day 3).
The results:
CGMS showed no statistically significant difference in blood
sugar levels on day on dialysis using glucose charged dialysate (day 2)
compared to day before dialysis (day 1) (p=0.255) and day after dialysis
(day 3) (p=0.318).
There was also no significant difference between blood sugar 12
hours on day before dialysis (day 1), 12 hours on day of dialysis and
blood sugar 12 hours on day after dialysis (day 3) by sensor.
As regarding glucometer, blood sugar didn’t show any significant
difference on day of dialysis (day 2) compared to day before dialysis (day
1) (p=0.215) and day after dialysis (day 3) (p=0.113). There was also no
significant difference between blood sugar on (day 1) and blood sugar on
(day 3) (p=0.716).
There was no statistically significant difference between sensor and
glucometer blood sugar readings on day before dialysis (day 1), day on
dialysis (day 2) or day after dialysis (day 3).
There was a high statistically significant correlation between sensor
and glucometer blood sugar readings on day before dialysis (day 1), day
on dialysis (day 2) or day after dialysis (day 3).