Abstract: Objectives  To analyze the rules and influencing factors of intradialytic blood glucose change and hypoglycemia, and to explore the effect of glucose-containing dialysate (GCD) on intradialytic hypoglycemia.  Methods  The maintenance hemodialysis (MHD) patients treated in the Blood Purification Center, The Second Hospital of Jilin University from December 2021 to December 2022 were enrolled in this study. They were routinely treated with glucose-free dialysate (GFD), and then switched to GCD containing 5.5mmol/L glucose. Blood glucose was assayed at 0, 1st， 2nd, 3rd hour and the end of last session of hemodialysis with GFD, and of the 4th session of hemodialysis with GCD.  Intradialytic blood glucose changes and hypoglycemia were compared between the MHD patients with and without diabetes. Univariate and multivariate logistic regression were used to analyze the influencing factors for intradialytic hypoglycemia in MHD patients with diabetes.   Results  A total of 232 MHD patients were enrolled in this study, including 102 in diabetes group and 130 in non-diabetes group. When they were dialyzed with GFD, hypoglycemia occurred in 21 cases in diabetes group (3 episodes of hypoglycemia occurred during dialysis after 0~2 hour and 21 episodes occurred during dialysis after 2 hours to end of the session), and in 6 cases in non-diabetes group (6 episodes occurred during dialysis after 2 hours to end of the session). Asymptomatic hypoglycemia accounted for 79.17% and 83.33% of the hypoglycemia in diabetes group and non-diabetes group respectively. The incidences of hypoglycemia were 20.59 % and 4.62% in diabetes group and non-diabetes group respectively (c2=14.180, P＜0.001). After the hemodialysis switched to GCD, hypoglycemia occurred in one case (0.98%) in diabetes group, significantly lower than the incidence of 20.59 % when GFD was used (P＜0.001); no hypoglycemia occurred in non-diabetes group. Pre-dialytic blood glucose≥10mmol/L (OR=0.185, 95% CI 0.054~0.636, P=0.007) and withdrawal of hypoglycemic medications on dialysis day (OR=0.226, 95% CI 0.073~0.707, P=0.011) were the protective factors for intradialytic hypoglycemia, while diabetes course≥20 years (OR=3.280, 95% CI 1.046~10.286,P=0.042) was the risk factor for intradialytic hypoglycemia. Conclusion   The last 2 hours of a dialysis session is the period when hypoglycemia, especially asymptomatic hypoglycemia, frequently occurs. GCD with a glucose concentration of 5.5mmol/L can effectively reduce the prevalence of hypoglycemia. Diabetes course ≥20 years is the risk factor for intradialytic hypoglycemia; withdrawal of hypoglycemic medications on dialysis day and pre-dialytic blood glucose ≥10mmol/L are the protective factors for intradialytic hypoglycemia.

Key words: Maintenance hemodialysis, Diabetes mellitus, Hypoglycemia, Glucose-free dialysate, Glucose-containing dialysate