Abstract: SA-PO554
Hypoglycemia and Mortality Risk in Incident Hemodialysis Patients
Session Information
- Diabetic Kidney Disease: Pathology, Epidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Kang, Duk-Hee, Ewha University College of Medicine, Seoul, Korea (the Republic of)
- Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
- You, Amy Seung, University of California, Irvine, Orange, California, United States
- Lee, Yong kyu, University of California Irvine, Huntington Beach, California, United States
- Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
- Rhee, Connie, University of California Irvine, Huntington Beach, California, United States
Background
Hypoglycemia is a frequent occurrence in chronic kidney disease (CKD) patients due to alterations in glucose and insulin metabolism. Yet there are sparse data examining the predictors and clinical implications of hypoglycemia, including mortality risk, among incident hemodialysis patients.
Methods
Among 58,304 incident hemodialysis patients receiving care from a large national dialysis organization over the period 2007-2011, we first examined clinical characteristics associated with risk of hypoglycemia, defined as a blood glucose concentration of <70 mg/dL, in the first year of dialysis using expanded case-mix and laboratory-adjusted logistic regression models. We then examined the association between hypoglycemia during the first year of dialysis with all-cause mortality risk using expanded case-mix and laboratory adjusted Cox models.
Results
In the first year of dialysis, hypoglycemia was observed among 16.8% of diabetic and 6.9% of non-diabetic incident hemodialysis patients. In adjusted logistic regression models, clinical characteristics associated with higher risk of hypoglycemia included younger age, female sex, African-American race, presence of a central venous catheter, lower residual renal function, and longer dialysis session length. In the overall cohort, patients who experienced hypoglycemia had a higher risk of all-cause mortality (reference: absence of hypoglycemia): adjusted HR (95% CI) 1.08 (1.04, 1.13). In stratified analyses, hypoglycemia was also associated with higher mortality risk in the diabetic and non-diabetic subgroups: adjusted HRs (95% CIs) 1.08 (1.04-1.13) and 1.17 (0.94-1.45), respectively.
Conclusion
Hypoglycemia was a frequent occurrence among both diabetic and non-diabetic hemodialysis patients, and was associated with higher mortality risk. Further studies are needed to identify approaches that ameliorate risk of hypoglycemia in hemodialysis patients.
Funding
- NIDDK Support