Glycemic assessment in patients receiving hemodialysis can be challenging because glucose levels may vary across the dialysis cycle and may not be fully captured by glycated hemoglobin (HbA1c). A prospective observational study published in Diabetes, Obesity and Metabolism evaluated continuous glucose monitoring (CGM)-derived glycemic patterns and their associations with interdialytic weight gain (IDWG) and intradialytic adverse events in insulin-treated adults receiving maintenance hemodialysis.

Forty participants underwent 2 weeks of CGM monitoring, contributing 11,096 glucose readings across 246 hemodialysis sessions. CGM metrics were analyzed during pre-dialytic, intradialytic, and post-dialytic periods. Multivariable regression examined associations between CGM measures, HbA1c, IDWG, intradialytic hypoglycemia, and intradialytic hypotension (IDH).

Time in range (TIR; 3.9-10.0 mmol/L) increased from 36.1% before dialysis to 60.9% during dialysis (P<0.001), then declined to 17.8% after dialysis (P<0.001). Mean glucose fell by 32% during treatment, from 11.1 mmol/L at initiation to an intradialytic nadir of 7.6 mmol/L at 125 minutes. Lower baseline 14-day TIR, but not HbA1c or glucose at dialysis initiation, was independently associated with higher IDWG, which was an independent risk factor for recurrent IDH.

Intradialytic hypoglycemia occurred in 20.0% of participants and was associated with higher baseline 14-day time below range (<3.9 mmol/L; OR 2.42 per 1% increase; P=0.049). These findings suggest CGM may identify clinically relevant glycemic risk patterns beyond HbA1c in patients receiving hemodialysis.