Int Urol Nephrol. 2026 Oct 19. doi: 10.1007/s11255-026-05388-7. Online ahead of print.
ABSTRACT
OBJECTIVE: To investigate the dose-response relationship between Glycemic variability (GV) and Intradialytic hypotension (IDH) in diabetic hemodialysis (MHD) patients, identify the critical Coefficient of variation (CV) threshold, and inform precision glucose management.
METHODS: This prospective cohort enrolled 240 diabetic MHD patients (2023-2024). Continuous glucose monitoring provided GV parameters (CV, MAGE, SD). Patients were divided into IDH (n = 98) and non-IDH (n = 142) groups. Restricted cubic spline (RCS) analyzed dose-response; multivariate logistic regression assessed independent effects, with Subgroup analysis and interaction tests.
RESULTS: CV was significantly higher in the IDH group (42.3% vs. 26.5%, P<0.001). RCS revealed a nonlinear positive correlation (P<0.001). When CV>36%, IDH risk increased sharply (threshold effect). Each 10% CV rise increased IDH risk by 98.4% (OR 1.984). Compared to Q1, Q3 (OR 3.512) and Q4 (OR 8.637) showed significantly higher risk. Associations were stronger in patients aged ≥60 years, dialysis duration ≥36 months, or with cardiovascular disease (interaction P<0.05). CV predicted IDH with AUC=0.856; optimal cutoff 36.5% (sensitivity 78.6%, specificity 82.4%).
CONCLUSION: A significant dose-response relationship exists between GV and IDH. CV>36% is an independent risk factor. Maintaining CV below 36% may reduce IDH risk and improve outcomes.
PMID:42895696 | DOI:10.1007/s11255-026-05388-7