Incidence and risk factors associated with hypoglycemia among patients with chronic kidney disease: A systematic review

Aleissa, Mohammed S.; AlGhofaili, Ibrahim A; Alotaibe, Haifa F; Yaslam, Maram; Almujil, Mohammed S.; Arnous, Maha M.; Dalbhi, Sultan K Al

doi:10.4103/jfcm.jfcm_304_19

Cited by 5 publications

(2 citation statements)

References 28 publications

(35 reference statements)

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“…Although HbA 1c is widely used as a target of glycemic control, it cannot reflect glucose variability or extent of hypoglycemia . There is a need to consider FBG level in practice, and the information on optimal on-treatment FBG levels may be relevant in treatment of patients with CKD, among whom hypoglycemia is common . In addition, the biennial measurement of urine albumin and serum creatinine could potentially lead to errors in time to event analyses.…”

Section: Discussionmentioning

confidence: 99%

“…25 There is a need to consider FBG level in practice, and the information on optimal on-treatment FBG levels may be relevant in treatment of patients with CKD, among whom hypoglycemia is common. 26,27 In addition, the biennial measurement of urine albumin and serum creatinine could potentially lead to errors in time to event analyses. However, in this 9-year follow-up study, the 1 year or 2 years earlier or later detection of albuminuria or creatinine doubling may not considerably influence the results.…”

Section: Limitationsmentioning

confidence: 99%

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Evaluation of Serum Glucose and Kidney Disease Progression Among Patients With Diabetes

Jung

2021

JAMA Netw Open

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IMPORTANCE The appropriate target of glycemic control in diabetic kidney disease is unclear. OBJECTIVE To investigate optimal on-treatment glycemic levels associated with slowing of diabetic kidney disease progression. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using nationwide Korean cohorts from the National Health Information Database from 2005 to 2019. Included individuals were adults with diabetes using antihyperglycemic agents with and without chronic kidney disease (CKD) identified from participants aged 40 to 74 years in a nationwide health screening survey conducted from 2009 to 2010. Data were analyzed from October 2020 through March 2021. EXPOSURE On-treatment fasting blood glucose (FBG) level. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of doubling of serum creatinine, end-stage kidney disease, or death from CKD. RESULTS Among 183 049 adults with diabetes using antihyperglycemic agents (mean [SD] age, 61.7 [8.4] years; 99 110 [54.1%] men), there were 131 401 individuals with dipstick albuminuria or an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m 2 (mean [SD] age, 62.4 [8.3] years; 71 280 [54.2%] men) and 51 648 individuals with no CKD (mean [SD] age, 59.6 [8.4] years;27 830 [53.9%] men). During 9 years of follow-up, the primary outcome occurred among 13 802 individuals with CKD (10.5%) and 1421 individuals with no CKD (2.8%). On-treatment FBG level had a J-shaped hazard ratio (HR) curve for the primary outcome. Among patients with albuminuria, FBG levels of 126 mg/dL to less than 140 mg/dL (HR, 0.87; 95% CI, 0.81-0.94) and 140 mg/dL to less than 160 mg/dL (HR, 0.90; 95% CI, 0.84-0.96) were associated with decreased risk and levels of 160 mg/dL to less than 180 mg/dL were associated with increased risk (HR, 1.10; 95% CI, 1.03-1.18) compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with decreased eGFR, FBG levels of 80 mg/dL to less than 100 mg/dL (HR, 1.30; 95% CI, 1.20-1.42) and levels of 160 mg/dL to less than 180 mg/dL (HR, 1.13; 95% CI, 1.04-1.23) were associated with increased risk of the primary outcome compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with no CKD, FBG levels of 80 mg/dL to less than 100 mg/dL (HR, 1.29; 95% CI, 1.01-1.65) and levels of 126 mg/dL to less than 140 mg/dL (HR, 1.23; 95% CI, 1.03-1.47) were associated with increased risk compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with no albuminuria at baseline, FBG levels of 140 mg/dL to less than 160 mg/dL (HR, 1.14; 95% CI, 1.09-1.20) were associated with increased risk of new-onset albuminuria, while levels of 100 mg/dL to less than 110 mg/dL were not associated with increased risk compared with FBG levels of 110 mg/dL to less than 126 mg/dL. For all-cause mortality, while FBG levels of 160 mg/dL to less than 180 mg/dL (HR, 1.20; 95% CI, 1.12-1.28) were associated with increased risk among patients with albuminuria, FBG (continued) Key Points Question What is the ...

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Evaluation of Serum Glucose and Kidney Disease Progression Among Patients With Diabetes

Jung

2021

JAMA Netw Open

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Hypoglycemia risk with inappropriate dosing of glucose-lowering drugs in patients with chronic kidney disease: a retrospective cohort study

Chang

Chou

et al. 2023

Sci Rep

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The incidence rates and consequences of inappropriate dosing of glucose-lowering drugs remain limited in patients with chronic kidney disease (CKD). A retrospective cohort study was conducted to estimate the frequency of inappropriate dosing of glucose-lowering drugs and to evaluate the subsequent risk of hypoglycemia in outpatients with an estimated glomerular filtration rate (eGFR) of < 50 mL/min/1.73 m2. Outpatient visits were divided according to whether the prescription of glucose-lowering drugs included dose adjustment according to eGFR or not. A total of 89,628 outpatient visits were included, 29.3% of which received inappropriate dosing. The incidence rates of the composite of all hypoglycemia were 76.71 and 48.51 events per 10,000 person-months in the inappropriate dosing group and in appropriate dosing group, respectively. After multivariate adjustment, inappropriate dosing was found to lead to an increased risk of composite of all hypoglycemia (hazard ratio 1.52, 95% confidence interval 1.34, 1.73). In the subgroup analysis, there were no significant changes in the risk of hypoglycemia regardless of renal function (eGFR < 30 vs. 30–50 mL/min/1.73 m2). In conclusion, inappropriate dosing of glucose-lowering drugs in patients with CKD is common and associated with a higher risk of hypoglycemia.

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Pharmacist consult to prevent hypoglycemia in adult inpatients with renal dysfunction

Uricchio,

Antoniello,

Dugan

et al. 2024

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The objective of this study was to evaluate the impact of a pharmacist consult service on rates of hypoglycemia in adult inpatients with renal dysfunction receiving antidiabetic medications. Methods This was a single-center, institutional review board–approved, quasi-experimental, 2-phase prospective study. Adult inpatients admitted within 48 to 96 hours of hospitalization with a creatine clearance of less than 30 mL/min or estimated glomerular filtration rate of less than 30 mL/min/1.73 m2 and an active antidiabetic medication order were included. Patients located in a critical care unit or with a previous or planned transplantation were excluded. Each phase was conducted over 4 months. The primary endpoint was the change in the incidence of hypoglycemic episodes (blood glucose [BG] of <70 mg/dL) per 100 patient days when comparing the cohorts. Secondary endpoints included the incidence of recurrent and severe (BG of <40 mg/dL) episodes of hypoglycemia per 100 patient days, occurrence of a BG concentration of higher than 300 mg/dL, and length of stay. Results Overall, 150 patients were included in the retrospective preimplementation phase and 172 were included in the prospective postimplementation phase. In the postimplementation group, there was a significant decrease in the rate of hypoglycemia per 100 patient days when compared to the retrospective group (5.8 vs 9.0; incidence rate ratio, 1.55; 95% confidence interval, 1.2-2.0; P < 0.05). There was no difference in secondary endpoints between the groups. Conclusion The implementation of a pharmacy consult service resulted in lower rates of hypoglycemic events, which supports pharmacist involvement to prevent hypoglycemia in this at-risk population. Additional studies involving pharmacists working under collaborative practice agreements may reinforce the results.

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Incidence and risk factors associated with hypoglycemia among patients with chronic kidney disease: A systematic review

Cited by 5 publications

References 28 publications

Evaluation of Serum Glucose and Kidney Disease Progression Among Patients With Diabetes

Evaluation of Serum Glucose and Kidney Disease Progression Among Patients With Diabetes

Hypoglycemia risk with inappropriate dosing of glucose-lowering drugs in patients with chronic kidney disease: a retrospective cohort study

Pharmacist consult to prevent hypoglycemia in adult inpatients with renal dysfunction

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