Abstract: SA-PO056

Risk of Hypoglycemia after Hospital Discharge Following AKI

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Hung, Adriana, TVHS Veterans Administration, Nashville, Tennessee, United States
  • Matheny, Michael Edwin, TVHS Veterans Administration, Nashville, Tennessee, United States
  • Siew, Edward D., Vanderbilt Division of Nephrology and Hypertension, Nashville, Tennessee, United States
  • Wilson, Otis D, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Perkins, Amy, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Greevy, Robert, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Abdel-Kader, Khaled, Vanderbilt Division of Nephrology and Hypertension, Nashville, Tennessee, United States
  • Parr, Sharidan, TVHS Veterans Administration, Nashville, Tennessee, United States
  • Ikizler, Talat Alp, Vanderbilt Division of Nephrology and Hypertension, Nashville, Tennessee, United States
  • Speroff, Theodore, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Hypoglycemia remains a common life-threatening complication in patients with diabetes. The risk of hypoglycemia after acute kidney injury (AKI) is not well defined. In this study we evaluate the risk of hypoglycemia in patients with diabetes within 90 days post-discharge between hospitalizations with and without AKI.

Methods

We performed a propensity-matched analysis of patients with and without AKI using a retrospective national cohort of Veterans with diabetes 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 an outpatient blood glucose < 60 mg/dL. Time to incident hypoglycemia within 90 days was examined using Cox proportional hazards models. Pre-specified subgroup analyses by renal recovery and baseline CKD and HbA1c status were performed

Results

We identified 65,206 propensity score matched pairs with and without AKI. The incidence per 100 person-years for hypoglycemia was 29.7 (95% confidence interval [CI]: 28.9-30.4) for patients with AKI and 23.7 (95% CI: 23.0-24.4) for patients without AKI, hazard ratio (HR): 1.25 (95% CI: 1.19-1.30). After adjustment, AKI was associated with 26% increased risk of incident hypoglycemia HR: 1.26 (95%CI: 1.21-1.32). The risk of hypoglycemia varied by degree of renal recovery. For patients with full recovery, the HR was 1.17 (95% CI: 1.11-1.24), for partial recovery, the HR was 1.29 (95% CI: 1.22-1.37), and for no recovery, the HR was 1.45 (95% CI: 1.34-1.57) compared to those with no AKI.

Conclusion

AKI is a risk factor for developing hypoglycemia in the 90 days following discharge from a hospitalization, and the risk is modified by the degree of renal recovery. Guidelines for increased monitoring and treatment modification post-AKI need to be developed

Funding

  • Veterans Affairs Support