Abstract
Overhydration may influence glycemic control in patients with type 2 diabetes (T2D) undergoing hemodialysis (HD). We investigated whether the extracellular-to-total body water ratio (ECW/TBW), a marker of fluid overload, is associated with Time in Range (TIR) and glucose variability (GV) in this population. Methods: In this prospective study, 61 insulin-treated T2D patients with end-stage kidney disease undergoing online hemodiafiltration (OL-HDF) underwent 20 days of continuous glucose monitoring (CGM). A ΔTIR > 5% between HD and non-HD days was defined as clinically relevant glycemic fluctuation. Hydration status was assessed using multifrequency bioimpedance analysis. Results: Patients with higher ECW/TBW ratios (> 0.395) showed worse glycemic control compared with those with lower ratios, including significantly lower TIR and higher mean glucose levels during both HD and non-HD days. Glycemic variability was also higher in the overhydrated group, with significantly increased standard deviation and coefficient of variation. In multivariable analysis, ECW/TBW ratio remained the only independent predictor of ΔTIR > 5% between HD and non-HD days (OR 6.99; 95% CI 1.91–25.66; p = 0.003). Linear regression analyses further demonstrated that higher ECW/TBW ratios were independently associated with lower TIR (B = − 637.7, p = 0.011). When interpreted per 0.01-unit increase in ECW/TBW ratio, this corresponds to an approximate 6.4% decrease in TIR. A higher ECW/TBW ratio was also associated with higher mean glucose (B = + 1346.6, p = 0.009) and greater glycemic variability measured by both standard deviation and coefficient of variation. Conclusion: Subclinical overhydration is independently associated with reduced TIR and increased glycemic variability in insulin-treated patients with T2D undergoing hemodialysis. These findings highlight the importance of assessing hydration status when optimizing glycemic management in this high-risk population.
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Abbreviations
- AGP:
-
Ambulatory glucose profile
- Alb:
-
Albumin
- AW:
-
Abdominal waist
- AUC:
-
Area under the curve
- AVF:
-
Arteriovenous fistula
- BIA:
-
Bioelectrical impedance analysis
- BMI:
-
Body mass index
- Ca:
-
Calcium
- Ca × Pi:
-
Calcium-phosphorus product
- CGM:
-
Continuous glucose monitoring
- CI:
-
Confidence interval
- CVC:
-
Central venous catheter
- CV:
-
Coefficient of variation
- CKD:
-
Chronic kidney disease
- ECW:
-
Extracellular water
- ECW/TBW:
-
Extracellular-to-total body water ratio
- ESKD:
-
End-stage kidney disease
- GMI:
-
Glucose management indicator
- GLP-1 RA:
-
Glucagon-like peptide-1 receptor agonist
- GFR:
-
Glomerular filtration rate
- GV:
-
Glycemic variability
- Hb:
-
Hemoglobin
- HbA1c:
-
Glycated hemoglobin
- HD:
-
Hemodialysis
- HP:
-
H-polymer membrane
- ICW:
-
Intracellular water
- Kt/V:
-
Dialysis adequacy index (urea clearance/distribution volume)
- MF-BIA:
-
Multifrequency bioelectrical impedance analysis
- mTOR:
-
Mechanistic target of rapamycin
- OL-HDF:
-
Online hemodiafiltration
- PA:
-
Phase angle
- PES:
-
Polysulfone membrane
- Pi:
-
Phosphorus
- PTH:
-
Parathyroid hormone
- ROC:
-
Receiver operating characteristic
- SD:
-
Standard deviation
- SGLT2i:
-
Sodium-glucose cotransporter-2 inhibitor
- SII:
-
Systemic immune-inflammation index
- SMI:
-
Skeletal muscle index
- TBW:
-
Total body water
- TAR1:
-
Time above range > 180 mg/dL
- TAR2:
-
Time above range > 250 mg/dL
- TBR1:
-
Time below range < 70 mg/dL
- TBR2:
-
Time BELOW RANGE < 54 mg/dL
- TIR:
-
Time in range (70–180 mg/dL)
- VFA:
-
Visceral fat area
- WC:
-
Waist circumference
- WHtR:
-
Waist-to-height ratio
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The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
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Gil-Millán, P., Lupiañez, A., Caparrós, S. et al. Subclinical overhydration predicts lower time in range and greater glycemic variability in type 2 diabetes on hemodialysis. Sci Rep (2026). https://doi.org/10.1038/s41598-026-49032-x
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DOI: https://doi.org/10.1038/s41598-026-49032-x
