Prevalence and factors associated with intradialytic hypoglycemia among chronic kidney disease patients on hemodialysis in nothern Tanzania

Background: Hypoglycemia is most prevalent among chronic kidney disease patients with or without diabetes mellitus (DM); initiation of hemodialysis poses a greater risk of hypoglycemia, which may lead to hospitalization or death. Factors that were found to associate with hypoglycemia are old age, female gender, duration of DM, hypoglycemic medications, history of hypoglycemia, malnutrition, comorbidities such as heart and liver failure, and drugs such as fluoroquinolone and beta blockers. This study has been undertaken to provide relevant clinical information to help predict the at-risk group, early diagnosis of asymptomatic and symptomatic intradialytic hypoglycemia (IDH), identification of associated factors for IDH, and glycemic patterns during hemodialysis which will improve the quality of hemodialysis (HD) sessions. Methods: A cross-sectional study included patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis (MHD) at Kilimanjaro Christian Medical Center (KCMC). Pre-dialysis blood glucose, 1st hour, 2nd hour and 4th hour during HD were measured using glucometer. Hypoglycemia were defined as blood glucose <3.9mmol/l with or without symptoms. Associated factor were determined by logistic regression analysis. A p-value of < 0.05 was deemed statistically significant.Results: A total of 122 patients were included, majority of the patients (68.03%) were men with a median age of 58 years (IQR: 44-68). Prevalence of intradialytic hypoglycemia (IDH) were 10.66%, majority (76.92%) were male and 69.23% were patients with DM. Elderly, duration of DM and duration of HD were found to be associated with hypoglycemia with a p- value of 0.033, 0.039 and 0.022, respectively. Downward trend of blood glucose were observed during dialysis despite of patients DM status, history of hypoglycemia or fasting, except patients who received intradialytic meal.Conclusions: IDH were prevalent and common among patients with DM, and were associated with an age greater than 66 years, DM duration of more than 15 years, and dialysis duration of more than 27 month. Downward trends of blood glucose were observed during HD with exceptions to those who received intradialytic meal.