Therapeutic Hypoglycemia to treat cancer
Author: Sture Hobro
Hemodialysis is the most common form of kidney dialysis and is typically given as a four-hour treatment in-hospital thrice weekly to more than 2 million end-stage kidney disease patients worldwide. In critical care hemodialysis for patients with acute kidney failure, blood is typically supplied to an extracorporeal circuit from a central dialysis catheter at a rate up to 300-400 mL/min to a dialyzer composed of a blood compartment and a dialysis fluid compartment separated by a semi-permeable membrane.
The fresh dialysis fluid is mixed in a dialysis machine with water and chemicals in dry or liquid form to concentrations desired for the patient’s blood. In many parts of the world, glucose is added to the dialysis fluid to avoid hypoglycemia. The dialysis fluid flow is typically twice the blood flow.
It is well-known that glucose levels in the blood are reduced when dialysis fluid without glucose is used. In fact, the idea of using dialysis to treat cancer is not new. For example, Mathews et al. suggested the use of dialysis to remove glucose and glutamine to a point where very little glucose is left in the blood.
Hemodialysis is very effective for small water-soluble substances such as electrolytes, glucose, and amino acids. Small water-soluble molecules are rapidly exchanged over the semipermeable dialysis membrane, and their levels in the blood leaving the dialyzer are similar (85–95%) to those in the dialysis fluid.
To achieve a therapeutic hypoglycemic state with dialysis, it is required to have a carbohydrate-restricted diet for 12 hours before the dialysis treatment to deplete the small amount of normally stored glycogen in the liver. However, other sources of energy as fat and protein are encouraged also during the CancerDialysis treatment, and patients could even receive appropriate parenteral nutrition during the treatment to compensate for the glucose and amino acid loss during the treatment.
Figure, Hemodialysis is the preferred method of renal replacement therapy, typically performed with blood access in the arm (a fistula) as shown in figure A. The treatment is generally well-tolerated with minor side effects. B. In CancerDialysis, a tunneled central dialysis catheter is suitable for blood access (figure B). A central venous catheter allows for long-term access (sometimes years) to the vein and CVC is bidirectional, allowing flows in and out at the same time. C. shows schematically the switch from a normal metabolic state dependent on glucose, to a therapeutic hypoglycemic state where glucose is strongly reduced.
