Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
Diabetes Res Clin Pract. 2018 Apr;138:106-112. doi: 10.1016/j.diabres.2018.01.008. Epub 2018 Feb 2.
A hyperglycemic crisis episode (HCE) is associated with poor management of diabetes, which is a risk factor for end-stage renal disease (ESRD); however, the association between an HCE and ESRD has not been clarified. We conducted a nationwide population-based cohort study with the purpose of delineating this issue.
We identified 9208 diabetic patients with an HCE and an identical number of diabetic patients with matched age, sex, and index date without an HCE between 2000 and 2002. A comparison of the risk of ESRD between the diabetic patients with and without an HCE was achieved by a follow-up until 2014.
A Cox proportional hazard regression analysis showed that the diabetic patients with an HCE were at a higher risk of ESRD than those without an HCE (the adjusted hazard ratio [AHR]: 1.47; 95% confidence interval [CI]: 1.34-1.62) by adjusting for renal disease, hypertension, hyperlipidemia, coronary artery disease, hyperuricemia, anemia, chronic obstructive pulmonary disease, liver disease, malignancy, connective tissue disease, non-steroid anti-inflammatory drug use, and monthly income. The increased risk of ESRD was more prominent in the age subgroup of 15-25 years (AHR: 4.91; 95% CI: 1.92-12.56); 25-35 years (AHR: 2.42; 95% CI: 1.51-3.86); 35-45 years (AHR: 3.01; 95% CI: 2.21-4.09); and 45-55 years (AHR: 1.75; 95% CI: 1.41-2.19).
An HCE was associated with an increased risk of ESRD, especially in the younger diabetic patients (15-55 years). A close follow-up for the control of diabetes and for monitoring renal function is proposed.
高血糖危象（HCE）与糖尿病管理不善有关，而糖尿病管理不善是终末期肾病（ESRD）的一个风险因素；然而，HCE 与 ESRD 之间的关系尚未阐明。我们进行了一项全国性基于人群的队列研究，旨在阐明这一问题。
我们在 2000 年至 2002 年期间，确定了 9208 名患有 HCE 的糖尿病患者和 9208 名年龄、性别和指数日期相匹配且没有 HCE 的糖尿病患者。通过随访至 2014 年，比较了患有和不患有 HCE 的糖尿病患者发生 ESRD 的风险。
Cox 比例风险回归分析表明，患有 HCE 的糖尿病患者发生 ESRD 的风险高于没有 HCE 的患者（调整后的危险比 [AHR]：1.47；95%置信区间 [CI]：1.34-1.62），同时调整了肾脏疾病、高血压、高血脂、冠心病、高尿酸血症、贫血、慢性阻塞性肺疾病、肝病、恶性肿瘤、结缔组织疾病、非甾体抗炎药使用和月收入。在年龄亚组（15-25 岁：AHR：4.91；95%CI：1.92-12.56）、25-35 岁（AHR：2.42；95%CI：1.51-3.86）、35-45 岁（AHR：3.01；95%CI：2.21-4.09）和 45-55 岁（AHR：1.75；95%CI：1.41-2.19），这种发生 ESRD 的风险更为显著。
HCE 与 ESRD 风险增加相关，尤其是在年轻的糖尿病患者（15-55 岁）中。建议密切随访糖尿病控制情况和监测肾功能。
