# Cardiometabolic Monitoring: Numbers Need Dialysis Context

Avoid hypoglycemia and treatment burden while pursuing realistic cardiovascular and functional goals. A better laboratory number is not the sole measure of benefit.

![Infographic: Cardiometabolic Monitoring: Numbers Need Dialysis Context](https://urinenephrology.org/visual-reference/images/mastery-hd-metabolic.png?v=20261003c)

## Risk is high, evidence differs

Lipid and glucose abnormalities occur in a setting of inflammation, altered clearance, vascular disease, and competing risks.

## Investigate HbA1c–glucose disagreement

Recent transfusion, ESA treatment, iron therapy, or shortened red-cell survival may make HbA1c misleading. Compare with measured glucose and hypoglycemia symptoms; consider CGM when useful. Do not intensify insulin solely because a biomarker and the clinical glucose pattern disagree.

## Use complementary information

Review hypoglycemia, nutritional intake, treatment-day patterns, and available glucose monitoring. Do not intensify treatment from one surrogate alone.

## Separate statin initiation from continuation

KDIGO lipid guidance generally discourages initiating a statin solely for primary prevention in dialysis-dependent CKD but supports continuation when already used at dialysis initiation. An acute coronary event creates a different individualized discussion. Do not translate a general LDL target into automatic escalation for every dialysis patient.

## Chair-side observations

Report recurrent low glucose, poor intake, dizziness, changes in medicines, and barriers to monitoring. Coordinate diet and medication timing with the care team.

## Focus on outcomes

Avoid hypoglycemia and treatment burden while pursuing realistic cardiovascular and functional goals. A better laboratory number is not the sole measure of benefit.

## Supporting evidence

- [Supporting guideline or source](https://kdigo.org/wp-content/uploads/2017/02/KI-Lipids-Summary-and-clinical-approach.pdf)

## Source lessons

- [cardiometabolic monitoring hd](https://urinenephrology.org/mastery/maintenance-hd/cardiometabolic-monitoring-hd.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.