Burden of impaired awareness of hypoglycemia in people with diabetes undergoing hemodialysis.

INTRODUCTION: Impaired awareness of hypoglycemia (IAH) refers to a diminished capacity to detect hypoglycemia. IAH can result in severe and even life-threatening outcomes for individuals with diabetes, especially those in advanced stages of the disease. This study aimed to assess the prevalence of IAH in people with diabetes on hemodialysis. RESEARCH DESIGN AND METHODS: We conducted a single-center audit to assess the prevalence of IAH using the Clarke questionnaire. Simultaneously, we measured fear of hypoglycemia with an adapted version of the Hypoglycemia Survey and recorded the incidence of severe hypoglycemia. Data were presented as mean±SD or counts/percentages. Logistic regression was then employed to analyze the association between IAH and various sociodemographic and clinical factors. RESULTS: We included 56 participants with diabetes on hemodialysis, with a mean age of 67.2 years (±12.9), of whom 51.8% were male. The ethnic distribution was 23.2% white, 23.2% black, 19.6% Asian, and 33.9% unspecified. The mean HbA1c was 52 mmol/mol (±18.6). The majority (91.1%) had a diagnosis of type 2 diabetes, and 55.4% of those were treated with insulin. The use of diabetes technology was low, with 2.8% of the participants using a continuous glucose monitor. IAH prevalence was 23.2%, and among the 57 participants, 23.6% had a history of severe hypoglycemia, and 60.6% reported fear of hypoglycemia. There were no significant differences in sociodemographic and clinical characteristics between those with IAH and normal hypoglycemia awareness. CONCLUSIONS: We observed that 23.2% of individuals with diabetes undergoing hemodialysis had IAH. IAH was more prevalent in people who reported a fear of hypoglycemia and had a history of severe hypoglycemia episode. The study highlights the unmet needs and disparities in access to diabetes technology within this population.

Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism / Efectividad y persistencia de los tratamientos del hiperparatiroidismo secundario en pacientes incidentes en hemodiálisis

Antecedentes: El inicio y la discontinuación del tratamiento antiparatiroideo son decisiones importantes en los pacientes en hemodiálisis crónica (HD) en los que la carga de pastillas es con frecuencia excesiva. El objetivo de este estudio es describir de tratamiento del hiperparatiroidismo secundario (sHPT) en pacientes en HD. Métodos: Estudio de cohorte, observacional retrospectivo de pacientes europeos incidentes en HD con sHPT a quienes se prescribió calcitriol o alfacalcidol (calcitriol-alfa), paricalcitol o cinacalcet. Resultados: Se incluyeron en el análisis pacientes que recibieron por primera vez calcitriol-alfa (N=2259), paricalcitol (N=1689) y cinacalcet (N=1245). Los valores sericos de hormona paratiroidea intacta (iPTH) disminuyeron tras iniciación con todos los tratamientos; los valores de calcio y fosforo serico se elevaron en respuesta al tratamiento con activadores de vitamina D pero disminuyeron con cinacalcet. Aproximadamente un tercio de los pacientes que recibieron calcitriol alfa y paricalcitol, y menos de una cuarta parte de los de cinacalcet discontinuaron el tratamiento. Aunque los tres grupos tuvieron descensos comparables de iPTH al momento de la interrupción del tratamiento, sin embargo difirieron en los valores de calcio y fosforo serico. Tras la interrupción, la evolución de los parámetros de laboratorio fué diferente según la modalidad de tratamiento: mientras que la iPTH se elevó en las tres modalidades, el calcio y fosforo sericos disminuyeron en los pacientes que estaban siendo tratados con calcitriol-alfa y paricalcitol en el momento de la interrupción y aumentaron en los que lo hacían con cinacalcet. Conclusiones: En condiciones clínicas que representan la práctica diaria, alcanzar y mantener los valores recomendados para el control del sHPT se consigue más frecuentemente con cinacalcet que con compuestos activos de vitamina D (AU)

Background: Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients. Methods: Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. Results: Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. Conclusions: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds (AU)

Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism.

BACKGROUND: Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients. METHODS: Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. RESULTS: Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. CONCLUSIONS: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.