{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:11:26Z","timestamp":1789056686931,"version":"build-2803163510"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["R01DK126373"],"award-info":[{"award-number":["R01DK126373"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015769","name":"Dexcom","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015769","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Hemodialysis disrupts glucose homeostasis: Levels fall during treatment, then rebound sharply afterward, often exceeding baseline.<\/jats:p>\n <\/jats:list-item>\n \n Postdialysis glucose rebound was higher and longer in people with diabetes, especially with insulin, but also occurred in people without diabetes.<\/jats:p>\n <\/jats:list-item>\n \n Hemodialysis disrupts glucoregulatory hormonal balance, and these disruptions may impair postprandial glucose disposal.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Hemodialysis affects glycemia in a manner that remains incompletely defined.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In a prospective cohort study, 342 participants on maintenance hemodialysis wore a Dexcom G6 Pro continuous glucose monitor (CGM) for 10 days while dialyzing with standardized 100 mg\/dl glucose dialysate. We examined glycemia relative to dialysis timing and tested associations of glycemia patterns with clinical characteristics and markers of overall glycemic control. Glucoregulatory hormones were measured before and after dialysis in a subset of 20 participants.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, CGM captured 1001 hemodialysis sessions. Among participants with treated diabetes (\n n<\/jats:italic>\n =143), with untreated diabetes (\n n<\/jats:italic>\n =78), and without diabetes (\n n<\/jats:italic>\n =121), predialysis glucose averaged 212\u00b184, 167\u00b165, and 120\u00b128 mg\/dl, respectively. During dialysis, glucose declined by 53\u00b179, 29\u00b155, and 7\u00b132 mg\/dl, respectively. After dialysis, glucose rebounded by 115\u00b170 mg\/dl (to mean peak 265\u00b184 mg\/dl), 95\u00b160 mg\/dl (227\u00b171 mg\/dl), and 61\u00b135 mg\/dl (168\u00b137 mg\/dl), respectively, with mean time to peak occurring later in treated (172 minutes after dialysis) and untreated (169 minutes) diabetes compared with no diabetes (140 minutes). Postdialytic rebound glycemia correlated with hemoglobin A1c and mean CGM glucose over the full observation period. Hypoglycemic events <70 mg\/dl were uncommon (\n N<\/jats:italic>\n =259); hypoglycemic event rates were significantly higher in the postdialysis period compared with time-matched periods on nondialysis days. There were no significant differences in hypoglycemic event rates before versus after dialysis on dialysis days. In the substudy, most glucoregulatory peptides declined significantly (\n P<\/jats:italic>\n < 0.001) during dialysis, including insulin (median change: \u221238%), glucagon (\u221243%), and glucagon-like peptide-1 (\u221238%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Hemodialysis induces intradialytic glucose declines and postdialytic rebound that link to overall glycemic control, highlighting dialysis as a physiologic stressor on glucose homeostasis.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001119","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:00:38Z","timestamp":1782921638000},"page":"1584-1592","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Cohort Study Evaluating Impact of Hemodialysis on Glycemia"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6284-731X","authenticated-orcid":false,"given":"Yoshio N.","family":"Hall","sequence":"first","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"},{"name":"Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8461-5111","authenticated-orcid":false,"given":"Leila R.","family":"Zelnick","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-8417","authenticated-orcid":false,"given":"Irl B.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6449-0243","authenticated-orcid":false,"given":"Andrew N.","family":"Hoofnagle","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"},{"name":"Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3780-294X","authenticated-orcid":false,"given":"Simon","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2769-6469","authenticated-orcid":false,"given":"Matthew B.","family":"Rivara","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"},{"name":"Northwest Kidney Centers, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1571-7592","authenticated-orcid":false,"given":"Ian H.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington"},{"name":"Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"5","key":"B1-20260910","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.kint.2022.08.012","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"102","author":"de Boer","year":"2022","journal-title":"Kidney Int."},{"issue":"10","key":"B2-20260910","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1089\/dia.2010.0067","article-title":"Analysis of hemodialysis-associated hypoglycemia in patients with type 2 diabetes using a continuous glucose monitoring system","volume":"12","author":"Jung","year":"2010","journal-title":"Diabetes Technol Ther."},{"issue":"7","key":"B3-20260910","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.2337\/dc08-1688","article-title":"Assessing glycemic control in maintenance hemodialysis patients with type 2 diabetes","volume":"32","author":"Kazempour-Ardebili","year":"2009","journal-title":"Diabetes Care."},{"issue":"11","key":"B4-20260910","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1055\/s-0034-1370963","article-title":"Influence of dialysis on the glucose profile in patients with diabetes: usefulness of continuous glucose monitoring","volume":"46","author":"Chantrel","year":"2014","journal-title":"Horm Metab Res."},{"issue":"5","key":"B5-20260910","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1053\/j.ajkd.2018.04.022","article-title":"Hypoglycemia-related hospitalizations and mortality among patients with diabetes transitioning to dialysis","volume":"72","author":"Rhee","year":"2018","journal-title":"Am J Kidney Dis."},{"issue":"1","key":"B6-20260910","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MNH.0000000000000756","article-title":"Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease","volume":"31","author":"Rhee","year":"2022","journal-title":"Curr Opin Nephrol Hypertens."},{"issue":"2","key":"B7-20260910","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.semnephrol.2021.03.004","article-title":"Glucose homeostasis, hypoglycemia, and the burnt-out diabetes phenomenon in kidney disease","volume":"41","author":"Rhee","year":"2021","journal-title":"Semin Nephrol."},{"issue":"4","key":"B8-20260910","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/j.1525-1594.2010.01112.x","article-title":"Characterization of insulin adsorption behavior of dialyzer membranes used in hemodialysis","volume":"35","author":"Abe","year":"2011","journal-title":"Artif Organs."},{"issue":"3","key":"B9-20260910","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/ndt\/gfu327","article-title":"Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients","volume":"30","author":"Jorgensen","year":"2015","journal-title":"Nephrol Dial Transplant."},{"issue":"10","key":"B10-20260910","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1089\/dia.2010.0052","article-title":"Inter-day glycemic variability assessed by continuous glucose monitoring in insulin-treated type 2 diabetes patients on hemodialysis","volume":"12","author":"Mirani","year":"2010","journal-title":"Diabetes Technol Ther."},{"issue":"3","key":"B11-20260910","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.diabres.2015.01.026","article-title":"Effectiveness of continuous glucose monitoring in dialysis patients with diabetes: the DIALYDIAB pilot study","volume":"107","author":"Joubert","year":"2015","journal-title":"Diabetes Res Clin Pract."},{"issue":"11","key":"B12-20260910","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1210\/clinem\/dgaf187","article-title":"Continuous glucose monitoring improves detection of glycemic excursions in hemodialysis patients with type 2 diabetes","volume":"110","author":"Galindo","year":"2025","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"B13-20260910","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jdiacomp.2014.12.015","article-title":"Blood glucose fluctuations in hemodialysis patients with end stage diabetic nephropathy","volume":"29","author":"Jin","year":"2015","journal-title":"J Diabetes Complications."},{"issue":"7","key":"B14-20260910","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1210\/jc.2013-3809","article-title":"Elimination and degradation of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide in patients with end-stage renal disease","volume":"99","author":"Idorn","year":"2014","journal-title":"J Clin Endocrinol Metab."},{"issue":"13","key":"B15-20260910","doi-asserted-by":"crossref","first-page":"10604","DOI":"10.3390\/ijms241310604","article-title":"Kinetics of glucoregulatory peptide hormones during hemodialysis with cellulose triacetate and polysulfone dialyzers in patients with diabetes and end-stage kidney disease","volume":"24","author":"Takao","year":"2023","journal-title":"Int J Mol Sci."},{"issue":"9","key":"B16-20260910","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1681\/ASN.0000000693","article-title":"Glycemia assessed by continuous glucose monitoring among people treated with maintenance dialysis","volume":"36","author":"de Boer","year":"2025","journal-title":"J Am Soc Nephrol."},{"issue":"7","key":"B17-20260910","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.2337\/dc22-0073","article-title":"Accuracy of a factory-calibrated continuous glucose monitor in individuals with diabetes on hemodialysis","volume":"45","author":"Villard","year":"2022","journal-title":"Diabetes Care."},{"issue":"11","key":"B18-20260910","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.2337\/dc24-0635","article-title":"Accuracy of continuous glucose monitoring in hemodialysis patients with diabetes","volume":"47","author":"Narasaki","year":"2024","journal-title":"Diabetes Care."},{"issue":"9","key":"B19-20260910","doi-asserted-by":"crossref","first-page":"sfae045","DOI":"10.1093\/ckj\/sfae045","article-title":"Performance of an interstitial glucose monitoring device in patients with type 1 diabetes during haemodialysis","volume":"17","author":"Cornet","year":"2024","journal-title":"Clin Kidney J."},{"issue":"5","key":"B20-20260910","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1089\/dia.2024.0575","article-title":"Accuracy of the dexcom G7 continuous glucose monitoring sensors in people with diabetes undergoing hemodialysis (ALPHA-2 study)","volume":"27","author":"Avari","year":"2025","journal-title":"Diabetes Technol Ther."},{"issue":"2","key":"B21-20260910","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/15209156251368934","article-title":"Accuracy of dexcom G6 pro and G7 continuous glucose monitors in patients treated with maintenance dialysis","volume":"28","author":"Zelnick","year":"2026","journal-title":"Diabetes Technol Ther."},{"issue":"2","key":"B22-20260910","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1089\/dia.2022.0284","article-title":"Assessment of the glucose management indicator using different sampling durations","volume":"25","author":"Bailey","year":"2023","journal-title":"Diabetes Technol Ther."},{"issue":"8","key":"B23-20260910","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.2337\/dci19-0028","article-title":"Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range","volume":"42","author":"Battelino","year":"2019","journal-title":"Diabetes Care."},{"issue":"11","key":"B24-20260910","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1089\/dia.2023.0287","article-title":"Testing the real-world accuracy of the dexcom G6 pro CGM during the insulin-only bionic pancreas pivotal trial","volume":"25","author":"Marak","year":"2023","journal-title":"Diabetes Technol Ther."},{"issue":"5","key":"B25-20260910","doi-asserted-by":"crossref","first-page":"835","DOI":"10.2337\/dc25-2952","article-title":"Accuracy, variability, and bias of glycemic biomarkers in patients treated with maintenance dialysis","volume":"49","author":"Zelnick","year":"2026","journal-title":"Diabetes Care."},{"key":"B26-20260910","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jmsacl.2022.06.003","article-title":"Multiplexed quantification of insulin and C-peptide by LC-MS\/MS without the use of antibodies","volume":"25","author":"Foulon","year":"2022","journal-title":"J Mass Spectrom Adv Clin Lab"},{"issue":"6","key":"B27-20260910","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1093\/clinchem\/hvae034","article-title":"Interlaboratory comparison of antibody-free LC-MS\/MS measurements of C-peptide and insulin","volume":"70","author":"Moradian","year":"2024","journal-title":"Clin Chem."},{"key":"B28-20260910","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jmsacl.2025.04.002","article-title":"Quantification of glucagon and oxyntomodulin by protein precipitation-immunoaffinity enrichment-LC-MS\/MS","volume":"36","author":"Becker","year":"2025","journal-title":"J Mass Spectrom Adv Clin Lab"},{"issue":"4","key":"B29-20260910","first-page":"242","article-title":"Occult hypoglycemia caused by hemodialysis","volume":"51","author":"Jackson","year":"1999","journal-title":"Clin Nephrol."},{"issue":"1","key":"B30-20260910","first-page":"dgz048","article-title":"Effect of the incretin hormones on the endocrine pancreas in end-stage renal disease","volume":"105","author":"Jorgensen","year":"2020","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"B31-20260910","doi-asserted-by":"crossref","first-page":"362","DOI":"10.5414\/CNP62362","article-title":"The mechanism of hypoglycemia caused by hemodialysis","volume":"62","author":"Takahashi","year":"2004","journal-title":"Clin Nephrol."},{"issue":"6","key":"B32-20260910","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1177\/1932296819882690","article-title":"Comparison of interstitial fluid glucose levels obtained by continuous glucose monitoring and flash glucose monitoring in patients with type 2 diabetes mellitus undergoing hemodialysis","volume":"14","author":"Yajima","year":"2020","journal-title":"J Diabetes Sci Technol."},{"issue":"1","key":"B33-20260910","doi-asserted-by":"crossref","first-page":"E107","DOI":"10.1152\/ajpendo.2002.282.1.E107","article-title":"Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation","volume":"282","author":"Ikizler","year":"2002","journal-title":"Am J Physiol Endocrinol Metab."},{"issue":"7","key":"B34-20260910","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.2337\/dc21-0269","article-title":"Hemodialysis-related glycemic disarray proven by continuous glucose monitoring; glycemic markers and hypoglycemia","volume":"44","author":"Hayashi","year":"2021","journal-title":"Diabetes Care."},{"issue":"6","key":"B35-20260910","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1007\/s00125-025-06388-5","article-title":"Cardiac arrhythmia and hypoglycaemia among individuals with and without diabetes receiving haemodialysis (the CADDY study): a Danish multicentre cohort study","volume":"68","author":"Kofod","year":"2025","journal-title":"Diabetologia."},{"issue":"1","key":"B36-20260910","doi-asserted-by":"crossref","first-page":"e0262880","DOI":"10.1371\/journal.pone.0262880","article-title":"Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis","volume":"17","author":"Afghahi","year":"2022","journal-title":"PLoS One."},{"key":"B37-20260910","doi-asserted-by":"crossref","first-page":"110016","DOI":"10.1016\/j.diabres.2022.110016","article-title":"Glycated hemoglobin levels and risk of all-cause and cause-specific mortality in hemodialysis patients with diabetes","volume":"190","author":"Kim","year":"2022","journal-title":"Diabetes Res Clin Pract"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:00:56Z","timestamp":1789056056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001119"}},"subtitle":["BLOSSOM (Blood Sugar Sensing On Maintenance Dialysis) Cohort Findings"],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":37,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000001119","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2026-02-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}