The evaluation of blood sugar kinetics during dialysis

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  • 血液透析患者の透析中における血糖動態について
  • ケツエキ トウセキ カンジャ ノ トウセキチュウ ニ オケル ケットウ ドウタイ ニ ツイテ

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Theoretically, the blood sugar level will not be less than the dialysate glucose concentration during dialysis. Therefore, evaluation of the relation between blood sugar kinetics and erythrocytes is considered in this study. For 120min, saline 1,000mL was recirculating to the dialyzer blood compartment (100mL/min) and dialysate flow was 500mL/min during evaluation of glucose diffusion in the dialyzer. The measured of glucose concentration in blood and dialysate compartment of the dialyzer. The dialysate glucose concentration showed three values (0, 100, and 150mg/dL), and the dialyzer used was an APS-15. Forty-two CKD (NIDDM group:18, IDDM group:6, and CGN group:18) was used for interaction between glucose and erythrocytes. The dialysate glucose concentration was 150mg/dL, dialysate flow was 500mL/min, blood flow 150~200mL/min, and the dialyzer was an APS-15. Blood samples were serially collected from dialyzer inlet pre-dialysis, and 2 hours after dialysis started. Then 0.5% glucose solution infusion (0.5mL) was centrifuged to collect erythrocytes from whole blood. These samples were incubated at 37°C and blood sugar levels were measured. The blood sugar levels at the dialyzer inlet and outlet were also measured to determine blood sugar kinetics in the dialyzer. At 0mg/dL, dialysate glucose concentration did not diffuse glucose between blood and dialysate compartment. At 100 and 150mg/dL, the glucose concentration in the blood and dialysate compartment were similar 30 minutes after the start of dialysis. Blood sugar levels in 0.5% glucose containing erythrocytes were 1.8% NIDDM, -4.5% IDDM, and 4.1% CGN, showing different changes in glucose levels compared to those pre HD. Two hrs after HD started, 0.5% glucose containing erythrocytes demonstrated values of -3.8% NIDDM, 4% IDDM, and -4.3% CGN. The three groups showed dialyzer outlet blood sugar levels that were less than dialysate glucose concentration. In conclusion, CKD blood sugar kinetics with erythrocytes differed between NIDDM, IDDM, and CGN. Erythrocyte intervention was considered the mechanism that decreased the blood sugar level in CKD.

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