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