Incidence and influencing factors for hypoglycemia in maintenance hemodialysis patients with diabetic kidney disease: a meta-analysis.

Abstract

The objective of this study was to evaluate the incidence of hypoglycemia in patients with diabetic kidney disease (DKD) undergoing maintenance hemodialysis (MHD) and to identify key factors influencing its occurrence. A comprehensive literature search was conducted across databases including CNKI, Wanfang data, VIP, SinoMed, PubMed, Cochrane Library, Web of Science and Embase from their inception to March 31, 2023. The search focused on studies addressing the incidence and influencing factors for hypoglycemia in DKD patients receiving hemodialysis. Eligible studies were selected based on predefined inclusion and exclusion criteria, and data were analyzed using Stata 15.0 software. A total of 24 studies involving 2388 patients were included in this meta-analysis, with 22 studies from China and 2 studies from English-speaking countries. The findings indicated that the incidence of hypoglycemia among hemodialysis patients with DKD was 41.7% (95% confidence interval (<i>CI</i>): 32.6% to 50.9%). Influencing factors associated with hypoglycemia in hemodialysis patients with DKD included age (odds ratio (OR) = 4.507, 95% <i>CI</i>: 3.272 to 6.209), course of DKD (<i>OR</i> = 3.547, 95% <i>CI</i>: 2.523 to 4.988), use of oral hypoglycemic drugs (<i>OR</i> = 4.643, 95% <i>CI</i>: 2.566 to 8.402), fasting plasma glucose (FPG) levels (risk ratio (RR) = 4.033, 95% <i>CI</i>: 2.594 to 6.269), insulin use (<i>OR</i> = 8.242, 95% <i>CI</i>: 4.517 to 15.042), application of glucose-free dialysate (RR = 7.987, 95% <i>CI</i>: 4.605 to 13.855), coefficient of variation in blood glucose (CVBG) (<i>OR</i> = 3.241, 95% <i>CI</i>: 2.071 to 5.071), mean blood glucose (MBG) (<i>OR</i> = 2.930, 95% <i>CI</i>: 1.635 to 5.248), medication compliance (<i>OR</i> = 4.300, 95% <i>CI</i>: 2.047 to 9.031) and self-care ability (<i>OR</i> = 3.543, 95% <i>CI</i>: 1.766 to 7.108). Specifically, risk factors identified were age > 60 years, DKD course > 1 year, use of oral hypoglycemic drugs, FPG < 6.1 mmol/L, insulin administration before dialysis, application of glucose-free dialysate, CVBG ≥ 0.26, MBG < 8.92 mmol/L, poor medication compliance, and poor self-care ability.