Risk of Hypoglycemia Following Hospital Discharge in Patients With Diabetes and Acute Kidney Injury
Risk of Hypoglycemia Following Hospital Discharge in Patients With Diabetes and Acute Kidney Injury
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DOI：
10.2337/dc17-1237
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发表时间：
2018-03-01
期刊：
影响因子：
16.2
通讯作者：
Matheny, Michael E.
中科院分区：
文献类型：
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作者：
Hung, Adriana M.;Siew, Edward D.;Matheny, Michael E.
目的低血糖在糖尿病患者中很常见。急性肾损伤(AKI)后低血糖的风险还没有很好的定义。这项研究的目的是比较有和没有AKI的糖尿病住院患者发生出院后低血糖的风险。研究设计和方法我们对有和没有AKI的糖尿病患者进行了倾向匹配分析，使用了2004至2012年间住院的全国退伍军人队列。AKI定义为住院期间血清肌酐从基线到峰值升高0.3 mg/dL或50%。低血糖定义为因低血糖而入院或急诊，或门诊血糖60 mg/dL。出院后90天内发生低血糖的时间采用COX比例风险模型进行检验。根据肾脏恢复、慢性肾脏疾病基线、入院前用药方案和糖化血红蛋白(1c)进行预先指定的亚组分析。结果我们确定了65,151对有和没有AKI的倾向分数匹配的配对。低血糖发生率分别为29.6(95%CI 28.9~30.4)和23.5(95%CI 22.9~24.2)/100人年。调整后，AKI与低血糖风险增加27%相关(危险比[HR]1.27[95%可信区间1.22-1.33])。与无AKI组比较，完全恢复组HR为1.18(95%CI 1.12~1.25)，部分恢复组HR为1.30(95%CI 1.23~1.37)，未恢复组HR为1.48(95%CI 1.36~1.60)。在所有抗糖尿病药物方案中，AKI患者发生低血糖的频率高于非AKI患者，但胰岛素使用者低血糖发生率最高，其次是格列本脲和格列吡嗪。结论AKI是出院后低血糖的危险因素。在这一人群中确定降低风险策略的研究是必要的。
OBJECTIVEHypoglycemia is common in patients with diabetes. The risk of hypoglycemia after acute kidney injury (AKI) is not well defined. The purpose of this study was to compare the risk for postdischarge hypoglycemia among hospitalized patients with diabetes who do and do not experience AKI.RESEARCH DESIGN AND METHODSWe performed a propensity-matched analysis of patients with diabetes, with and without AKI, using a retrospective national cohort of veterans hospitalized between 2004 and 2012. AKI was defined as a 0.3 mg/dL or 50% increase in serum creatinine from baseline to peak serum creatinine during hospitalization. Hypoglycemia was defined as hospital admission or an emergency department visit for hypoglycemia or as an outpatient blood glucose < 60 mg/dL. Time to incident hypoglycemia within 90 days postdischarge was examined using Cox proportional hazards models. Pre-specified subgroup analyses by renal recovery, baseline chronic kidney disease, pre-admission drug regimen, and HbA(1c) were performed.RESULTSWe identified 65,151 propensity score-matched pairs with and without AKI. The incidence of hypoglycemia was 29.6 (95% CI 28.9-30.4) and 23.5 (95% CI 22.9-24.2) per 100 person-years for patients with and without AKI, respectively. After adjustment, AKI was associated with a 27% increased risk of hypoglycemia (hazard ratio [HR] 1.27 [95% CI 1.22-1.33]). For patients with full recovery, the HR was 1.18 (95% CI 1.12-1.25); for partial recovery, the HR was 1.30 (95% CI 1.23-1.37); and for no recovery, the HR was 1.48 (95% CI 1.36-1.60) compared with patients without AKI. Across all antidiabetes drug regimens, patients with AKI experienced hypoglycemia more frequently than patients without AKI, though the incidence of hypoglycemia was highest among insulin users, followed by glyburide and glipizide users, respectively.CONCLUSIONSAKI is a risk factor for hypoglycemia in the postdischarge period. Studies to identify risk-reduction strategies in this population are warranted.