Incidence and factors associated with dialysis-related hypoglycaemia among patients with kidney failure at Kiruddu National Referral Hospital: a prospective longitudinal cohort study

Abstract

Kidney failure is the most advanced form of chronic kidney disease (CKD), causing the most years lived with disability from CKD. Among patients with kidney failure, pathophysiologic changes and therapeutic measures including haemodialysis (HD) may increase the risk of hypoglycaemia. Hypoglycaemia increases the risk of morbidity and death among patients with kidney failure. The incidence and factors associated with dialysis-related hypoglycaemia among patients with kidney failure attending HD in Uganda have not been described. To determine the incidence and factors associated with dialysis-related hypoglycaemia among adult patients with kidney failure at Kiruddu National Referral Hospital (KNRH) HD unit. This prospective cohort study consecutively recruited 122 participants with kidney failure attending routine HD sessions at KNRH in September 2022. A pretested questionnaire was administered and hourly capillary blood glucose measurements were done during a single 4-hour HD session. Dialysis-related hypoglycaemia was defined as a blood glucose reading ≤3.9mmol/L during HD. Participants were free to eat during HD and meal times were recorded. Multivariable Poisson regression was done using the generalized estimating equation to determine the factors associated with dialysis-related hypoglycaemia. Of the 122 participants, 54 (44.3%) experienced 82 episodes of hypoglycaemia, and 5 patients (4.1%) experienced 8 episodes of serious clinically relevant hypoglycaemia. None of the episodes of hypoglycaemia was severe. The incidence rate was 16.9 hypoglycaemia events per 100 persons per hour on HD (95% CI 13.9-20.6). Overall, the incidence of hypoglycaemia increased significantly with time during HD IRR 1.33 (95%CI 1.07-1.64). The incidence rate of hypoglycaemia increased faster among patients 7.8mmol/L. The risk of hypoglycaemia increased faster time among those who did not eat during HD. There was a high incidence rate of asymptomatic hypoglycaemia in this study population, with 16.9 events per 100 patients per hour. This warrants assessment of pre-HD blood glucose levels, and proven measures to elevate and sustain higher blood glucose levels during HD, like meals, glucose infusions or glucose-containing dialysis solutions.