Article

Frequency of hypoglycemia and its significance in chronic kidney disease.

Department of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
Clinical Journal of the American Society of Nephrology (impact factor: 5.23). 05/2009; 4(6):1121-7. DOI:10.2215/CJN.00800209 pp.1121-7
Source: PubMed

ABSTRACT This study set out to determine the incidence of hypoglycemia in patients with chronic kidney disease (CKD), with and without diabetes, and the association of hypoglycemia with mortality.
This was a retrospective cohort analysis of 243,222 patients who had 2,040,206 glucose measurements and were cared for at the Veterans Health Administration. CKD was defined as an estimated GFR of <60 ml/min per 1.73 m(2). Hypoglycemia was set at <70 mg/dl. Mortality was measured 1 day after glucose measurement.
The incidence of hypoglycemia was higher in patients with CKD versus without CKD. Among patients with diabetes, the rate was 10.72 versus 5.33 per 100 patient-months and among patients without diabetes was 3.46 versus 2.23 per 100 patient-months, for CKD versus no CKD, respectively. The odds of 1-d mortality were increased at all levels of hypoglycemia but attenuated in CKD versus no CKD. Adjusted odds ratios for 1-d mortality that were associated with glucose values of <50, 50 to 59, and 60 to 69 mg/dl, respectively, versus glucose of >or=70 mg/dl were 6.09, 4.10, and 1.85 for inpatient records from patients with CKD; 9.95, 3.79, and 2.54 for inpatients records from patients without CKD; 6.84, 3.28, and 3.98 for outpatient records from patients with CKD; and 13.28, 7.36, and 4.34 for outpatient records from patients without CKD.
CKD is a risk for hypoglycemia, with or without diabetes. The excessive mortality associated with hypoglycemia makes this complication a significant threat to patient safety in CKD.

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Keywords

1 day
 
1-d mortality
 
100 patient-months
 
Adjusted odds ratios
 
cared
 
chronic kidney disease
 
CKD
 
diabetes
 
estimated GFR
 
excessive mortality
 
glucose
 
glucose measurement
 
glucose values
 
Hypoglycemia
 
inpatient records
 
inpatients records
 
patients
 
retrospective cohort analysis
 
significant threat
 
Veterans Health Administration
 

Maureen F Moen