THE EFFECTS OF DIFFERENT DIALYSIS TREATMENTS ON GLYCEMIC EXCURSIONS AND INFLAMMATION IN PATIENTS WITH END-STAGE RENAL DISEASE WITH AND WITHOUT TYPE 2 DIABETES MELLITUS

Introduction and Aims: It is known that hemodialysis dialyzes out blood glucose, and that hemodinamic change during session induces stress hormones and inflammatory citokines.The aim of this study was to evaluate the glycemic excursions and the changes of various inflammatory parameters in type 2 diabetic patients affected by end-stage renal disease undergoing bicarbonate dialysis (BHD) and hemodiafiltration (HDF) compared to euglycemic patients. Methods: Twenty patients (11 affected by type 2 diabetes mellitus, and 9 not diabetic patients) were evaluated.We measured, before and after dialysis, these parameters: body mass index (BMI), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting plasma insulin (FPI),HOMA-IR, lipid profile, homocysteine (Hcy), high sensitivity C-reactive protein (hs-CRP), fibrinogen, lipoprotein (a) [Lp(a)], metalloproteinases-2, and -9 (MMP-2 and MMP-9), interleukins 6 (IL-6), and -8 (IL-8), and soluble receptor for advanced glycation end products (sRAGE). All patients underwent glucose continuous monitoring system, using The iPro Continuous Glucose Monitor System (Medtronic MiniMed) starting just before the bicarbonate dialysis, and ending five days later, after the HDF dialysis. Results:We observed a significant decrease of glycemic excursions during BHD respect to HDF.We also observed a statistically significant decrease of MMP-9 (p<0.001) after bicarbonate dialysis, but not after HDF. Considering only type 2 diabetic patients, we observed a decrease of sRAGE with bicarbonate dialysis ( p<0.01), but not with HDF. Moreover, in type 2 diabetic patients, there was a significant correlation between glycemia and MMP-9 (r=0.5689, p<0.05). On the other hand, in not diabetic patients, there was a positive correlation between glycemia and Lp (a) (r=0.3785, p<0.05), and between glycemia and MMP-9 (r=0.2792, p<0.05). Conclusions:We can conclude that bicarbonate dialysis seems reduce glycemic excursions during the treatment respect to HDF, and induces decrease of inflammatory markers, therefore more adapted to the treatment of type 2 diabetic uremic patients.