Clinical innovation of glucose-containing dialysate: transition from osmotic regulation to multisystem regulation_West China Medical Journal

Authors：

ZHOU Zhifeng ,  ZHANG Ling

Department of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Ling, Email: zhangling_crrt@163.com

Keywords：

Hemodialysis; glucose-containing dialysate; multisystem regulation; glucose regulation; blood regulation

DOI：

10.7507/1002-0179.202506139

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Hemodialysis, serving as a crucial renal replacement therapy for patients with end-stage kidney disease, has consistently prioritized the optimization of dialysate composition in clinical practice. The application of glucose-containing dialysate has undergone a conceptual evolution from its initial role in osmotic regulation to its current recognition as a multifunctional systemic modulator. Accumulating evidence demonstrates that glucose-containing dialysate exhibits distinctive clinical advantages in maintaining glycemic and hemodynamic stability while reducing heart rate variability among hemodialysis patients. Nevertheless, existing studies present certain limitations, including relatively small sample sizes and insufficient evaluation of long-term prognostic indicators. Consequently, future investigations should emphasize large-scale, multicenter clinical trials with extended follow-up periods to further substantiate the therapeutic benefits of glucose-containing dialysate in clinical practice.

1.	GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
2.	Sharma R, Rosner MH. Glucose in the dialysate: historical perspective and possible implications?. Hemodial Int, 2008, 12(2): 221-226.
3.	Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
4.	Yu TM, Lin CL, Chang SN, et al. Increased risk of stroke in patients with chronic kidney disease after recurrent hypoglycemia. Neurology, 2014, 83(8): 686-694.
5.	孙艳君. 含糖透析液对糖尿病透析患者透析低血糖和低血压的影响. 糖尿病新世界, 2017, 20(15): 37-38.
6.	韩雨, 曲志杰, 封文媛, 等. 维持性血液透析患者透析中血糖变化及低血糖发生情况分析. 中国血液净化, 2023, 22(6): 421-425.
7.	牙秋艳, 陈柱, 黄柳慧, 等. 含糖透析液在老年非糖尿病维持性透析患者中应用的有效性和安全性分析. 大医生, 2024, 9(11): 74-76.
8.	黎小燕, 杨光, 钟树妹. 老年终末期糖尿病肾病血透使用含糖透析液对低血糖及低血压发生率的影响. 中外医学研究, 2013(18): 18-19.
9.	张守清. 含糖或无糖透析液对糖尿病肾病血液透析患者平均动脉压和心率变异性的影响. 实用心脑肺血管病杂志, 2014(7): 73-74.
10.	李侠, 赵新菊, 曹立云, 等. 含糖透析液对维持性血液透析患者心率变异性和血压的影响. 中国血液净化, 2010, 9(3): 138-142.
11.	Raimann JG, Kruse A, Thijssen S, et al. Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial. Nephrol Dial Transplant, 2012, 27(4): 1559-1568.
12.	Simic-Ogrizovic S, Backus G, Mayer A, et al. The influence of different glucose concentrations in haemodialysis solutions on metabolism and blood pressure stability in diabetic patients. Int J Artif Organs, 2001, 24(12): 863-869.
13.	Bushljetik IR, Trajceska L, Pusevski V, et al. Glucose levels during dialysis with glucose-free versus glucose-rich dialysate fluid. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2019, 40(3): 41-46.
14.	Iatridi F, Theodorakopoulou MP, Karagiannidis AG, et al. Intradialytic hypertension in maintenance hemodialysis. Curr Hypertens Rep, 2024, 27(1): 1.
15.	Tislér A, Akócsi K, Borbás B, et al. The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. Nephrol Dial Transplant, 2003, 18(12): 2601-2605.
16.	赵谷天, 杨丽萍, 陈浩. 含糖透析液对维持性血透病人血透过程中血糖和血压水平的影响. 中外女性健康研究, 2021(13): 85-86.
17.	曹伟波. 含糖透析液对糖尿病肾病血液透析患者的影响. 中外医疗, 2017, 36(8): 25-27.
18.	王天智, 刘翠红. 含糖透析液在糖尿病肾病维持性血液透析病人中的应用. 中国妇幼健康研究, 2016, 27(增刊 1): 272-273.
19.	Khan MS, Javaid SS, Mentz RJ, et al. Heart rate variability in patients with cardiovascular diseases. Prog Cardiovasc Dis, 2025.
20.	Padilla VJ, Scheffrahn K, Muñiz V, et al. Heart rate variability, hypnosis, and psychotherapy. Appl Psychophysiol Biofeedback, 2025, 50(2): 289-295.
21.	任迎, 胡作祥, 单薇, 等. 含糖透析液对糖尿病肾病血液透析患者血压和心率变异性的影响. 中国现代医生, 2011(25): 31-33.
22.	Ferrario M, Raimann JG, Thijssen S, et al. Effects of dialysate glucose concentration on heart rate variability in chronic hemodialysis patients: results of a prospective randomized trial. Kidney Blood Press Res, 2011, 34(5): 334-343.
23.	Li M, Li Y, Lv J, et al. The effects of glucose-free and glucose-containing dialysate during dialysis in MHD patients: a prospective cross-over study. Perfusion, 2023, 38(1): 178-185.
24.	Dolegowska B, Stepniewska J, Ciechanowski K, et al. Does glucose in dialysis fluid protect erythrocytes in patients with chronic renal failure?. Blood Purif, 2007, 25(5/6): 422-429.
25.	Bober J, Kwiatkowska E, Kedzierska K, et al. Does glucose present in the dialysate limit oxidative stress in patients undergoing regular hemodialysis?. Blood Purif, 2005, 23(3): 219-225.

1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
2. Sharma R, Rosner MH. Glucose in the dialysate: historical perspective and possible implications?. Hemodial Int, 2008, 12(2): 221-226.
3. Cui L, Meng Y, Xu D, et al. Analysis of the metabolic properties of maintenance hemodialysis patients with glucose-added dialysis based on high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Ther Clin Risk Manag, 2013, 9: 417-425.
4. Yu TM, Lin CL, Chang SN, et al. Increased risk of stroke in patients with chronic kidney disease after recurrent hypoglycemia. Neurology, 2014, 83(8): 686-694.
5. 孙艳君. 含糖透析液对糖尿病透析患者透析低血糖和低血压的影响. 糖尿病新世界, 2017, 20(15): 37-38.
6. 韩雨, 曲志杰, 封文媛, 等. 维持性血液透析患者透析中血糖变化及低血糖发生情况分析. 中国血液净化, 2023, 22(6): 421-425.
7. 牙秋艳, 陈柱, 黄柳慧, 等. 含糖透析液在老年非糖尿病维持性透析患者中应用的有效性和安全性分析. 大医生, 2024, 9(11): 74-76.
8. 黎小燕, 杨光, 钟树妹. 老年终末期糖尿病肾病血透使用含糖透析液对低血糖及低血压发生率的影响. 中外医学研究, 2013(18): 18-19.
9. 张守清. 含糖或无糖透析液对糖尿病肾病血液透析患者平均动脉压和心率变异性的影响. 实用心脑肺血管病杂志, 2014(7): 73-74.
10. 李侠, 赵新菊, 曹立云, 等. 含糖透析液对维持性血液透析患者心率变异性和血压的影响. 中国血液净化, 2010, 9(3): 138-142.
11. Raimann JG, Kruse A, Thijssen S, et al. Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial. Nephrol Dial Transplant, 2012, 27(4): 1559-1568.
12. Simic-Ogrizovic S, Backus G, Mayer A, et al. The influence of different glucose concentrations in haemodialysis solutions on metabolism and blood pressure stability in diabetic patients. Int J Artif Organs, 2001, 24(12): 863-869.
13. Bushljetik IR, Trajceska L, Pusevski V, et al. Glucose levels during dialysis with glucose-free versus glucose-rich dialysate fluid. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2019, 40(3): 41-46.
14. Iatridi F, Theodorakopoulou MP, Karagiannidis AG, et al. Intradialytic hypertension in maintenance hemodialysis. Curr Hypertens Rep, 2024, 27(1): 1.
15. Tislér A, Akócsi K, Borbás B, et al. The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. Nephrol Dial Transplant, 2003, 18(12): 2601-2605.
16. 赵谷天, 杨丽萍, 陈浩. 含糖透析液对维持性血透病人血透过程中血糖和血压水平的影响. 中外女性健康研究, 2021(13): 85-86.
17. 曹伟波. 含糖透析液对糖尿病肾病血液透析患者的影响. 中外医疗, 2017, 36(8): 25-27.
18. 王天智, 刘翠红. 含糖透析液在糖尿病肾病维持性血液透析病人中的应用. 中国妇幼健康研究, 2016, 27(增刊 1): 272-273.
19. Khan MS, Javaid SS, Mentz RJ, et al. Heart rate variability in patients with cardiovascular diseases. Prog Cardiovasc Dis, 2025.
20. Padilla VJ, Scheffrahn K, Muñiz V, et al. Heart rate variability, hypnosis, and psychotherapy. Appl Psychophysiol Biofeedback, 2025, 50(2): 289-295.
21. 任迎, 胡作祥, 单薇, 等. 含糖透析液对糖尿病肾病血液透析患者血压和心率变异性的影响. 中国现代医生, 2011(25): 31-33.
22. Ferrario M, Raimann JG, Thijssen S, et al. Effects of dialysate glucose concentration on heart rate variability in chronic hemodialysis patients: results of a prospective randomized trial. Kidney Blood Press Res, 2011, 34(5): 334-343.
23. Li M, Li Y, Lv J, et al. The effects of glucose-free and glucose-containing dialysate during dialysis in MHD patients: a prospective cross-over study. Perfusion, 2023, 38(1): 178-185.
24. Dolegowska B, Stepniewska J, Ciechanowski K, et al. Does glucose in dialysis fluid protect erythrocytes in patients with chronic renal failure?. Blood Purif, 2007, 25(5/6): 422-429.
25. Bober J, Kwiatkowska E, Kedzierska K, et al. Does glucose present in the dialysate limit oxidative stress in patients undergoing regular hemodialysis?. Blood Purif, 2005, 23(3): 219-225.

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