Impact and safety assessment of glucose-containing dialysate on blood pressure and glycemic variability in maintenance hemodialysis patients_West China Medical Journal

Authors：

BU Qiongxing ^1,2 , HE Xin ³ , ZHU Dan ⁴ , XUE Hen ⁵ , HE Jing ⁶ , LI Hualin ⁷ , YANG Ling ⁸ , XIANG Bo ⁹ , QING Yonghong ¹⁰ , LI Li ¹¹ , ZHANG Yaolin ¹² , HE Li ¹³ , CHEN Lin ¹³ , ZHOU Zhifeng ¹ , ZHANG Ling ¹ ,  OU Santao ¹⁴

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shan’xi 046000, P. R. China;
3. Department of Nephrology, Chengdu Kangfu Nephrology Hospital, Chengdu, Sichuan 610041, P. R. China;
4. Department of Nephrology, General Medical Chengdu 363 Hospital, Chengdu, Sichuan 610041, P. R. China;
5. Department of Nephrology, Ya’an People’s Hospital, Ya’an, Sichuan 625000, P. R. China;
6. Department of Nephrology, Bazhong Central Hospital, Bazhong, Sichuan 636600, P. R. China;
7. Department of Nephrology, Nanbu People’s Hospital, Nanbu, Sichuan 637000, P. R. China;
8. Department of Nephrology, Emeishan People’s Hospital, Emeishan, Sichuan 614200, P. R. China;
9. Department of Nephrology, Longchang People’s Hospital, Longchang, Sichuan 642159, P. R. China;
10. Department of Nephrology, Fushun Chinese Medicine Hospital, Fushun, Sichuan 643299, P. R. China;
11. Department of Nephrology, Jiangyou 903 Hospital, Jiangyou, Sichuan 621700, P. R. China;
12. Department of Nephrology, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;
13. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
14. Department of Nephrology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

OU Santao, Email: ousantao@163.com

Keywords：

Glucose-containing dialysate; glucose-free dialysate; maintenance hemodialysis; blood pressure variability; glycemic variability; hypotension episodes; hypoglycemic episodes

DOI：

10.7507/1002-0179.202507024

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Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on blood pressure variability and blood glucose variability in maintenance hemodialysis (MHD) patients and to assess safety. Methods MHD patients from 12 hospitals were enrolled between October 2024 and June 2025. According to the randomized block design, patients were randomly divided into the glucose-containing dialysate group (experimental group) and the glucose-free dialysate group (control group). During hemodialysis sessions, blood pressure were monitored at 0, 1, 2, 3, and 4 hours, and blood glucose was measured at 0, 2, and 4 hours monthly for six consecutive months. Hypotension episodes and hypoglycemic episodes were recorded throughout dialysis. Results A total of 244 MHD patients were included, with 122 in each group. Compared with the control group, the experimental group showed significantly lower systolic blood pressure variability [dialysis for 2 hours: 9.92 (7.92, 12.52) vs. 11.95 (9.45, 15.36) mm Hg (1 mm Hg=0.133 kPa), P<0.001; during the 0-2 hour dialysis period: 2.60 (1.24, 3.97) vs. 3.74 (2.03, 6.52) mm Hg, P=0.011], diastolic blood pressure variability [during the 0-4 hour dialysis period: 3.85 (1.49, 6.69) vs. 4.72 (1.99, 8.46) mm Hg, P<0.001], blood glucose variability [dialysis for 2 hours: 0.16 (0.12, 0.20) vs. 0.18 (0.13, 0.23) mmol/L, P=0.002; dialysis for 4 hours: 0.17 (0.13, 0.22) vs. 0.21 (0.17, 0.26) mmol/L, P<0.001; during the 2-4 hour dialysis period: 0.04 (0.02, 0.08) vs. 0.07 (0.03, 0.10) mmol/L, P=0.004], incidence rates of hypotension (32.9% vs. 33.3%, P=0.005) and incidence rates of hypoglycemia (0.42% vs. 4.02%, P<0.001). Conclusions Glucose-containing dialysate reduces both blood pressure variability and blood glucose variability more effectively than glucose-free dialysate during hemodialysis. Compared with glucose-free dialysate, the glucose-containing dialysate demonstrated a lower incidence of hypotension episodes and hypoglycemic episodes.

1.	Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet, 2015, 385(9981): 1975-1982.
2.	Ren Z, Zhang M, Wang P, et al. Research on the development of an intelligent prediction model for blood pressure variability during hemodialysis. BMC Nephrology, 2025, 26(1): 82.
3.	Zhang L, Zou L, Zhou L. Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis. Ren Fail, 2024, 46(1): 2331613.
4.	Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension, 2000, 36(5): 901-906.
5.	Chang TI, Tabada GH, Yang J, et al. Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease. J Hypertens, 2016, 34(2): 244-252.
6.	Cheng Y, Li Y, Zhang F, et al. Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients. Medicine (Baltimore), 2020, 99(29): e21232.
7.	Chang TI, Flythe JE, Brunelli SM, et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens, 2013, 28(1): 18-24.
8.	Buscemi S, Re A, Batsis JA, et al. Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in type 2 diabetes. Diabetic Medicine, 2010, 27(8): 872-878.
9.	艾衣坦·阿依特哈孜, 青琴. 无糖与含糖透析液对糖尿病肾病患者血糖的影响研究. 中外医疗, 2017, 36(2): 85-87.
10.	孙艳君. 含糖透析液对糖尿病透析患者透析低血糖和低血压的影响. 糖尿病新世界, 2017, 20(15): 37-38.
11.	王天智, 刘翠红. 含糖透析液在糖尿病肾病维持性血液透析病人中的应用. 中国妇幼健康研究, 2016, 27(S1): 272-273.
12.	张金林. 糖尿病肾病患者应用无糖及含糖透析液对血糖的影响. 中国临床医生杂志, 2016, 44(8): 51-52.
13.	Li M, Li Y, Lv J, et al. The effects of glucose-free and glucose-containing dialysate during dialysis in MHD patients: a prospective cross-over study. Perfusion, 2023, 38(1): 178-185.
14.	李侠, 赵新菊, 曹立云, 等. 含糖透析液对维持性血液透析患者心率变异性和血压的影响. 中国血液净化, 2010, 9(3): 138-142.
15.	Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care, 2017, 40(12): 1631-1640.
16.	de Havenon A, Petersen N, Wolcott Zet al. Effect of dihydropyridine calcium channel blockers on blood pressure variability in the SPRINT trial: a treatment effects approach. J Hypertens, 2022, 40(3): 462-469.
17.	Assimon MM, Flythe JE. Definitions of intradialytic hypotension. Semin Dial, 2017, 30(6): 464-472.
18.	Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care, 2005, 28(5): 1245-1249.
19.	Burmeister JE, Miltersteiner Dda R, Burmeister BO, et al. Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia. Arch Endocrinol Metab, 2015, 59(2): 137-140.
20.	蹇丽君, 张凌, 关明镜, 等. 含糖透析液对合并糖尿病的维持性血液透析患者血糖、血压和心率变异性的影响. 西部医学, 2024, 36(5): 776-780.
21.	Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with Meta-analysis. Am J Nephrol, 2019, 49(6): 497-506.
22.	Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol, 2015, 11(5): 302-313.
23.	Rubinger D, Revis N, Pollak A, et al. Predictors of haemodynamic instability and heart rate variability during haemodialysis. Nephrol Dial Transplant, 2004, 19(8): 2053-2060.
24.	Quagliaro L, Piconi L, Assaloni R, et al. Intermittent high glucose enhances ICAM-1, VCAM-1 and E-selectin expression in human umbilical vein endothelial cells in culture: the distinct role of protein kinase C and mitochondrial superoxide production. Atherosclerosis, 2005, 183(2): 259-267.
25.	Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
26.	Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J, 2020, 13(6): 981-993.
27.	Ricks J, Molnar MZ, Kovesdy CP, et al. Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study. Diabetes, 2012, 61(3): 708-715.
28.	Ceriello A, Esposito K, Piconi L, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes, 2008, 57(5): 1349-1354.
29.	Pitsillides AN, Anderson SM, Kovatchev B. Hypoglycemia risk and glucose variability indices derived from routine self-monitoring of blood glucose are related to laboratory measures of insulin sensitivity and epinephrine counterregulation. Diabetes Technol Ther, 2011, 13(1): 11-17.
30.	Cherian AK, Briski KP. A2 noradrenergic nerve cell metabolic transducer and nutrient transporter adaptation to hypoglycemia: impact of estrogen. J Neurosci Res, 2012, 90(7): 1347-1358.
31.	El Youssef J. IN CONTROL of type 1 diabetes, despite hypoglycaemia unawareness. Lancet Diabetes Endocrinol, 2016, 4(11): 874-875.
32.	李琴, 郝丽荣. 含糖透析液在血液透析中应用的利与弊. 现代医学, 2018, 46(5): 586-589.
33.	Khoo CY, Gao F, Choong HL, et al. Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis. Ann Acad Med Singap, 2022, 51(3): 136-142.
34.	Daugirdas JT. Dialysis hypotension: a hemodynamic analysis. Kidney Int, 1991, 39(2): 233-246.
35.	曹伟波. 含糖透析液对糖尿病肾病血液透析患者的影响. 中外医疗, 2017, 36(8): 25-27.

1. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet, 2015, 385(9981): 1975-1982.
2. Ren Z, Zhang M, Wang P, et al. Research on the development of an intelligent prediction model for blood pressure variability during hemodialysis. BMC Nephrology, 2025, 26(1): 82.
3. Zhang L, Zou L, Zhou L. Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis. Ren Fail, 2024, 46(1): 2331613.
4. Kikuya M, Hozawa A, Ohokubo T, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension, 2000, 36(5): 901-906.
5. Chang TI, Tabada GH, Yang J, et al. Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease. J Hypertens, 2016, 34(2): 244-252.
6. Cheng Y, Li Y, Zhang F, et al. Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients. Medicine (Baltimore), 2020, 99(29): e21232.
7. Chang TI, Flythe JE, Brunelli SM, et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens, 2013, 28(1): 18-24.
8. Buscemi S, Re A, Batsis JA, et al. Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in type 2 diabetes. Diabetic Medicine, 2010, 27(8): 872-878.
9. 艾衣坦·阿依特哈孜, 青琴. 无糖与含糖透析液对糖尿病肾病患者血糖的影响研究. 中外医疗, 2017, 36(2): 85-87.
10. 孙艳君. 含糖透析液对糖尿病透析患者透析低血糖和低血压的影响. 糖尿病新世界, 2017, 20(15): 37-38.
11. 王天智, 刘翠红. 含糖透析液在糖尿病肾病维持性血液透析病人中的应用. 中国妇幼健康研究, 2016, 27(S1): 272-273.
12. 张金林. 糖尿病肾病患者应用无糖及含糖透析液对血糖的影响. 中国临床医生杂志, 2016, 44(8): 51-52.
13. Li M, Li Y, Lv J, et al. The effects of glucose-free and glucose-containing dialysate during dialysis in MHD patients: a prospective cross-over study. Perfusion, 2023, 38(1): 178-185.
14. 李侠, 赵新菊, 曹立云, 等. 含糖透析液对维持性血液透析患者心率变异性和血压的影响. 中国血液净化, 2010, 9(3): 138-142.
15. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care, 2017, 40(12): 1631-1640.
16. de Havenon A, Petersen N, Wolcott Zet al. Effect of dihydropyridine calcium channel blockers on blood pressure variability in the SPRINT trial: a treatment effects approach. J Hypertens, 2022, 40(3): 462-469.
17. Assimon MM, Flythe JE. Definitions of intradialytic hypotension. Semin Dial, 2017, 30(6): 464-472.
18. Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care, 2005, 28(5): 1245-1249.
19. Burmeister JE, Miltersteiner Dda R, Burmeister BO, et al. Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia. Arch Endocrinol Metab, 2015, 59(2): 137-140.
20. 蹇丽君, 张凌, 关明镜, 等. 含糖透析液对合并糖尿病的维持性血液透析患者血糖、血压和心率变异性的影响. 西部医学, 2024, 36(5): 776-780.
21. Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with Meta-analysis. Am J Nephrol, 2019, 49(6): 497-506.
22. Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol, 2015, 11(5): 302-313.
23. Rubinger D, Revis N, Pollak A, et al. Predictors of haemodynamic instability and heart rate variability during haemodialysis. Nephrol Dial Transplant, 2004, 19(8): 2053-2060.
24. Quagliaro L, Piconi L, Assaloni R, et al. Intermittent high glucose enhances ICAM-1, VCAM-1 and E-selectin expression in human umbilical vein endothelial cells in culture: the distinct role of protein kinase C and mitochondrial superoxide production. Atherosclerosis, 2005, 183(2): 259-267.
25. Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
26. Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J, 2020, 13(6): 981-993.
27. Ricks J, Molnar MZ, Kovesdy CP, et al. Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study. Diabetes, 2012, 61(3): 708-715.
28. Ceriello A, Esposito K, Piconi L, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes, 2008, 57(5): 1349-1354.
29. Pitsillides AN, Anderson SM, Kovatchev B. Hypoglycemia risk and glucose variability indices derived from routine self-monitoring of blood glucose are related to laboratory measures of insulin sensitivity and epinephrine counterregulation. Diabetes Technol Ther, 2011, 13(1): 11-17.
30. Cherian AK, Briski KP. A2 noradrenergic nerve cell metabolic transducer and nutrient transporter adaptation to hypoglycemia: impact of estrogen. J Neurosci Res, 2012, 90(7): 1347-1358.
31. El Youssef J. IN CONTROL of type 1 diabetes, despite hypoglycaemia unawareness. Lancet Diabetes Endocrinol, 2016, 4(11): 874-875.
32. 李琴, 郝丽荣. 含糖透析液在血液透析中应用的利与弊. 现代医学, 2018, 46(5): 586-589.
33. Khoo CY, Gao F, Choong HL, et al. Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis. Ann Acad Med Singap, 2022, 51(3): 136-142.
34. Daugirdas JT. Dialysis hypotension: a hemodynamic analysis. Kidney Int, 1991, 39(2): 233-246.
35. 曹伟波. 含糖透析液对糖尿病肾病血液透析患者的影响. 中外医疗, 2017, 36(8): 25-27.

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