How Continuous Glucose Monitoring Reveals Hidden Risks in Dialysis Patients

Original Article: https://www.medscape.com/viewarticle/continuous-glucose-monitoring-uncovers-hidden-glycemic-risks-2025a1000u40

Study Highlights & Why It Matters

A recent study has shown that continuous glucose monitoring (CGM) may be a useful tool for patients undergoing dialysis for kidney disease—particularly those with diabetes—because it uncovers episodes of high and low blood sugar that traditional tests may miss. This latest research examined a large, fairly diverse group of dialysis patients to map out their glucose patterns in real life, rather than relying on standard lab tests alone. 

What the Study Found in Dialysis Patients

In the study, 420 people on maintenance dialysis wore a CGM device for about ten days. Among them, 263 had diabetes and 157 did not. For participants without diabetes, those undergoing peritoneal dialysis had higher average blood sugar levels (141 mg/dL) compared with those on hemodialysis (121 mg/dL). For participants with untreated diabetes, the average blood sugar was 162 mg/dL, with only 64% having a time in range of 70% or more, and the average HbA1c was 5.7%. Among those receiving diabetes treatment, the average blood sugar jumped to 214 mg/dL, and the time in range averaged 43% (only 22% achieved a time in range of 70%). Furthermore, researchers documented 714 episodes of low blood sugar across the cohort, including 179 classified as severe. Interestingly, the highest rate of hypoglycemia was seen in patients without diabetes undergoing hemodialysis. 

What This Tells Us About Current Monitoring

This study highlights that in dialysis patients, standard monitoring tools like HbA1c may not tell the full story when it comes to glucose fluctuations. As one of the study’s investigators noted, “we knew going in that HbA1c is inaccurate for dialysis patients, but we didn’t expect to see how high blood sugars were when measured by CGM.” The work opens up questions about how best to monitor: What exactly causes these unusual glucose patterns? Do they affect how patients feel or function? And what changes in management could reduce risk? 

Limitations & Next Steps

While the findings are informative, the study had limitations: CGM devices may have measurement imprecision especially in dialysis patients, possibly leading to misclassification of glycemia. Also, though the data suggest risk, the study doesn’t yet tell us how best to change treatment or management to improve outcomes in this population. 

What This Means for Patients

For people undergoing dialysis, these results suggest that their glucose levels may fluctuate more than expected—both high and low—and these fluctuations might go undetected by standard tests. Knowing this may help motivate discussions with one’s care team about whether enhanced monitoring like CGM could be appropriate. At the same time, CGM isn’t yet standard for all dialysis patients and the best uses, timing and implications are still under study.