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