Best Practice for Diabetic Patients on Hemodialysis 2012

Abstract

I. GLYCEMIC CONTROL (1) Targets for glycemic control Statements 1. Predialysis casual plasma glucose and glycated albumin (GA) levels are recommended as indicators for glycemic control. 2. The hemoglobin A1c (HbA1c) level might be used only as reference, because HbA1c level decreases in the presence of anemia or erythropoiesis-stimulating agents (ESAs) and may not accurately represent glycemic control in hemodialysis patients. 3. Tentative targets for glycemic control: predialysis casual plasma glucose levels (or 2-h postprandial plasma glucose levels) <180-200 mg/dL and GA levels <20.0% are recommended for hemodialysis patients. GA levels <24.0% are suggested for hemodialysis patients with a history of cardiovascular events and who have hypoglycemic episodes. Further studies are required to definitively determine target values. 4. In glycemic control, multiple indicators, including predialysis casual plasma glucose and GA levels, should be comprehensively evaluated to reduce the risk of hypoglycemia and improve the prognosis of patients. Commentary 1. Targets for glycemic control in general diabetic patients Glycemic control in diabetic patients affects the development and progression of microvascular