Glucose Homeostasis and the Burnt-Out Diabetes Phenomenon in Patients with Kidney Disease

  • Masanori AbeEmail author
  • Csaba P. Kovesdy
  • Kamyar Kalantar-Zadeh


The kidney contributes to glucose homeostasis through the processes of gluconeogenesis, glucose filtration, glucose reabsorption, and glucose consumption. While diabetes is one of the most important causes of chronic kidney disease, the gradual decline in kidney function itself causes significant changes that alter glucose homeostasis in patients with kidney disease. In many patients with diabetic nephropathy requiring dialysis, glycemic control improves spontaneously with progression of chronic kidney disease, loss of residual kidney function, and initiation of dialysis, leading to normal-to-low hemoglobin A1c and glucose levels which require the cessation of insulin or other antidiabetic medications; this phenomenon is also known as “burnt-out diabetes.” In diabetic patients on chronic hemodialysis, very high as well as low glucose levels are associated with poor outcomes, including mortality. Glycemic control that is tailored to hemodialysis patients and glycemic control that differs from that of non-dialysis patients are needed to avoid hemodialysis-induced hypoglycemia and other glycemic disarrays.


Burnt-out diabetes Gluconeogenesis Glucose homeostasis Hyperglycemia Hypoglycemia Hemodialysis Chronic kidney disease 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Masanori Abe
    • 1
    Email author
  • Csaba P. Kovesdy
    • 2
  • Kamyar Kalantar-Zadeh
    • 3
  1. 1.Division of Nephrology, Hypertension, and Endocrinology, Department of Internal MedicineNihon University School of MedicineTokyoJapan
  2. 2.Division of Nephrology, Department of MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  3. 3.Division of Nephrology and Hypertension, Departments of Medicine, Pediatrics, Public Health, and Nursing Sciences, University of California Irvine School of MedicineOrangeUSA

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