AVII77. Whal's wife here .
We follow KDIGO recs which is that studies haven't shown improved CV outcomes in HD pts despite lowering LDL.(4D, Aurora,Sharp trials) Generally we don't start statins once pts are on HD but if they have already been taking statins, we will continue them. However some of the nephrologists do their own thing and put all their ESRD pts on statins.
With diabetics type 2, their need for insulin (on HD) often is reduced because of decreased insulin degradation and decreased renal gluconeogeneisis. Most oral DM2 drugs are excreted by kidneys, so we have to be careful of hypoglycemia .
HD is believed to alter insulin secretion, clearance and resistance ( uremia changes with HD treatment, acidosis and phosphate). Also the dextrose conc in dialysate can affect- either assoc w hypo or hyperglycemia.
DM2 management with CAPD (peritoneal dialysis) control of DM is more of issue as a hyper glucose solution is used and absorbed.
Finally malnutrition is a big issue for HD patients and protein wasting.
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AV ..Whal here. Hope that answers your question .
My wife wrote this quickly as she was literally about to go out the door to work at one of 3 dialysis clinics see's required to be at most days .
Her attitude was " So I'm at work before I even get to work ? "
Her meaning ...She knows I have great respect for your posts which is why she stopped to quickly try and answer your questions ....but she's generally not available for comment on message boards. .
Her patients are at the very high risk end of the dialysis population .
She had one patient this year go into cardiac arrest while in the dialysis chair when she was on the floor ...she dragged him onto the floor began chest compressions ( some one else "bagged " him ...oxygen I guess ) ...got a pulse back but patient died 2 days later.
Whal / Kiwi
