中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 104-109.doi: 10.3969/j.issn.1671-4091.2026.02.004

• 临床研究 • 上一篇    下一篇

含葡萄糖透析液对2型糖尿病维持性血液透析患者血糖及血压变异性的影响：一项单中心前瞻性自身交叉对照研究

尹 韬   李月红   温 雯   关惠丹   武向兰   

  1. 102218 北京，1 清华大学临床医学院 北京清华长庚医院肾脏内科
  • 收稿日期:2025-03-11 修回日期:2025-12-01 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 李月红 E-mail: lyha01051@btch.edu.cn

Effects of glucose-containing dialysate on glycemic and blood pressure variability in type 2 diabetic patients on maintenance hemodialysis: a single-center prospective self-crossover study

YIN Tao,  LI Yuehong,  WEN Wen,  GUAN Hui- dan,  WU Xiang-lan   

  1. Department of Nephrology, Peking Tsinghua Chang Geng Hospital; School of Clinical Medicine, Tsinghua University, Beijing 100000, China
  • Received:2025-03-11 Revised:2025-12-01 Online:2026-02-12 Published:2026-02-02
  • Contact: 102218 北京，1清华大学临床医学院 北京清华长庚医院肾脏内科 E-mail: lyha01051@btch.edu.cn

摘要：

目的 探讨含葡萄糖透析液与无葡萄糖透析液对2型糖尿病维持性血液透析(maintenance hemodialysis,MHD)患 者 血 糖 变 异 性(glycemic variability,GV)及 血 压 变 异 性(blood pressure variability，BPV)的影响。 方法 采用前瞻性自身交叉对照设计，纳入北京清华长庚医院的2型糖尿病MHD患 者，分别使用含葡萄糖和无葡萄糖透析液，对比2组患者透析过程中血糖及血压变化情况，并探讨含葡萄糖 透析液对不同基线糖化血红蛋白(glycosylated hemoglobin，HbA1c)范围患者的GV和BPV的影响。 结 果 透 析 前 基 线 血 压 与 血 糖 在 2 组 间 无 统 计 学 差 异(收 缩 压：t=-0.023，P =0.982，舒 张 压：t=-0.414， P=0.154，血 糖：t=0.301，P=0.764)。无 葡 萄 糖 透 析 液 应 用 时 在 透 析 2 h(t=2.162,P=0.033)与 4 h(t= 2.372，P=0.020)的收缩压高于含葡萄糖透析液应用；透析1h的舒张压高于含糖透析液应用时(t=-2.086, P=0.004)。透析过程中的血糖在1～4h均低于含葡萄糖透析液(1h：t=2.745,P=0.007；2h：t=3.950，P＜ 0.001；3h：t=6.070，P＜0.001；4h：t=6.890，P＜0.001)。GV(t=39.442，P＜0.001)及 SBPV(t=6.366，P= 0.012)在含葡萄糖透析液应用时低于无葡萄糖透析液，透析过程中的低血糖事件在含葡萄糖透析液应用 时减少(χ2 =17.370，P＜0.001)。不同基线HbA1c水平的患者GV及SBPV在含葡萄糖透析液应用时低于无 葡萄糖透析液(P＜0.05)；无论透析液类型如何，HbA1c 7%～8%组在透析中的SBPV与GV均为最低，与其他 2组存在统计学差异(F =13.183，P=0.001)。 结论 2型糖尿病MHD患者应用含葡萄糖透析液可有效降低 SBPV、GV及透析过程中低血糖风险。HbA1c 7%～8%的患者血液透析过程中血糖及血压波动幅度最小，提 示控制血糖的重要性。

关键词: 2型糖尿病, 血液透析, 糖化血红蛋白, 含葡萄糖透析液

Abstract: Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on glycemic variability (GV) and blood pressure variability (BPV) in patients with type 2 diabetes mellitus (T2DM) undergoing maintenance hemodialysis (MHD). Methods Using a prospective self-crossover controlled design, T2DM patients on MHD at Peking Tsinghua Chang Geng Hospital were enrolled. They sequentially used glucose-containing and glucose-free dialysate. Changes in blood glucose and blood pressure during dialysis were compared between the two conditions. The effects of glucose-containing dialysate on GV and BPV in patients with different baseline glycosylated hemoglobin (HbA1c) ranges were also explored. Results No statistically significant differences were observed in pre-dialysis baseline blood pressure or blood glucose between the two groups (systolic blood pressure [SBP]: t=-0.023, P=0.982; diastolic blood pressure [DBP]: t=-0.414, P=0.154; blood glucose: t=0.301, P=0.764). During the use of glucose-free dialysate, SBP was higher at 2 hours (t=2.162, P=0.033) and 4 hours (t=2.372, P=0.020) compared to during glucose-containing dialysate use; DBP was higher at 1 hour compared to during glucose-containing dialysate use (t=-2.086, P=0.004). Blood glucose during dialysis was lower from 1 to 4 hours with glucose-free dialysate than with glucose-containing dialysate (1 h: t = 2.745, P=0.007; 2 h: t= 3.950, P＜0.001; 3 h: t= 6.070, P＜0.001; 4 h: t=6.890, P＜0.001). Both GV (t=39.442, P＜0.001) and systolic blood pressure variability (SBPV, t=6.366, P=0.012) were lower with glucose-containing dialysate than with glucose-free dialysate. Hypoglycemic events during dialysis were reduced with glucose-containing dialysate (χ²=17.370, P＜0.001). For patients with different baseline HbA1c levels, both GV and SBPV were lower with glucose-containing dialysate than with glucose-free dialysate (P＜0.05). Regardless of dialysate type, the group with HbA1c 7%～8% exhibited the lowest SBPV and GV during dialysis, showing a statistically significant difference compared to the other two groups (F=13.183, P=0.001). Conclusions For T2DM patients on MHD, the use of glucose-containing dialysate can effectively reduce SBPV, GV, and the risk of hypoglycemia during dialysis. Patients with HbA1c levels between 7% and 8% demonstrated the smallest fluctuations in blood glucose and blood pressure during hemodialysis, highlighting the importance of glycemic control.

Key words: Type 2 diabetes, Hemodialysis, Glycated hemoglobin, Glucose-containing dialysate

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