Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

Abstract

BackgroundPatients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis.MethodsUsing National Health Insurance Research Database, 20,845 advanced DKD patients beginning long-term dialysis between 2002 and 2006 were enrolled. We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis.Results19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend < 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia. However, previous severe hypoglycemia was not correlated with risk of MI after dialysis.ConclusionsThe rate of severe hypoglycemia was high in advanced DKD patients. Patients with higher aDCSI scores tended to have more hypoglycemic episodes. Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients.

Protective Effects of Kaempferitrin on Advanced Glycation End Products Induce Mesangial Cell Apoptosis and Oxidative Stress

“…Diabetic nephropathy (DN) is a serious and common chronic microvascular complication of DM [ 2 ], that is the main cause of mortality in patients with diabetes, as well as a major contributor to the high prevalence of end-stage renal disease (ESRD) worldwide [ 3 ]. The global prevalence of DM is growing rapidly, especially in developing countries, and the incidence rates of both DN and ESRD continue to increase [ 4 ]. Hyperglycemia is accompanied by an accelerated rate of formation of advanced glycation end products (AGEs).…”

Effects of Keluoxin Capsule Combined with Losartan Potassium on Diabetic Kidney Disease with Qi and Yin Deficiency and Blood Stasis Syndrome: Study Protocol for a Randomized Double-Blind Placebo-Controlled Multicenter Clinical Trial

“…DKD is one of the most important microvascular complications of diabetes, and its prevalence has increased dramatically worldwide in the past few decades [3,4]. It has been reported that DKD accounts for approximately 20% of new dialysis prescriptions [5], and the high medical cost of renal dialysis treatment has created an urgent need for additional therapeutic strategies for DKD [6]. Comprehensive measures such as hypoglycemic and antihypertensive treatments have demonstrated bene cial effects in preventing the development of DKD, especially when used at the stage of microalbuminuria, and angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor II blockers (ARBs) reduce the risk of progression of DKD [7][8][9].…”

Improved glycemic control with minimal systemic metformin exposure: Effects of Metformin Delayed-Release (Metformin DR) targeting the lower bowel over 16 weeks in a randomized trial in subjects with type 2 diabetes

“…Treatment with these agents is complicated by the fact that renal disease is an independent risk factor for hypoglycemia through several mechanisms including decreased renal insulin clearance and reduced renal glucose production during counterregulation [ 21 – 23 ]. Furthermore, hypoglycemia is of particular concern in patients with advanced renal disease, as it leads to greater risk of declining renal function, stroke, and excessive mortality [ 22 , 24 – 26 ].…”