1Division of Endocrinology, Emory University School of Medicine, Atlanta, GA.
2Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA.
Diabetes Care. 2022 Jan 1;45(1):100-107. doi: 10.2337/dc21-1579.
We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabetes and end-stage kidney disease (ESKD).
This was a nationwide, retrospective study of adults (≥18 years old) with diabetes/ESKD, from the United States Renal Data System registry, between 2013 and 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1,000 person-years. Event rates and risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality, comorbidities, treatment regimen, and U.S. region.
Among 521,789 adults with diabetes/ESKD (median age 65 years [interquartile range 57-73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1,000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, respectively, the risks decreased with age and were lowest in older patients (≥75 vs. 18-44 years old: incidence rate ratio 0.35, 95% CI 0.33-0.37, and 0.03, 0.02-0.03), women (1.09, 1.06-1.12, and 1.44, 1.35-1.54), and those with smoking (1.36, 1.28-1.43, and 1.71, 1.53-1.91), substance abuse (1.27, 1.15-1.42, and 1.53, 1.23-1.9), retinopathy (1.10, 1.06-1.15, and 1.36, 1.26-1.47), and insulin therapy (vs. no therapy; 0.60, 0.59-0.63, and 0.44, 0.39-0.48). For hypoglycemia, specifically, additional risk was conferred by Black race (1.11, 1.08-1.15) and amputation history (1.20, 1.13-1.27).
In this nationwide study of patients with diabetes/ESKD, hypoglycemic crises were threefold more common than hyperglycemic crises, greatly exceeding national reports in nondialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected.
我们描述了糖尿病合并终末期肾病（ESKD）患者严重低血糖和高血糖危象（糖尿病酮症酸中毒/高血糖高渗状态）的年度趋势。
这是一项在美国肾脏数据系统登记处进行的全国性、回顾性研究，纳入了 2013 年至 2017 年期间年龄≥18 岁的糖尿病/ESKD 成年患者。主要结局是低血糖和高血糖危象急诊就诊或住院的年度发生率，以每 1000 人年发生的事件数报告。事件发生率和危险因素经患者年龄、性别、种族/民族、透析方式、合并症、治疗方案和美国地区进行了调整。
在 521789 例患有糖尿病/ESKD 的成年人中（中位年龄 65 岁[四分位间距 57-73]，56.1%为男性，46%为白人），低血糖和高血糖危象的总体调整后发生率分别为 53.64 和 18.24 例/1000 人年。对于低血糖和高血糖危象，风险分别随年龄增加而降低，在年龄较大的患者（≥75 岁与 18-44 岁：发病率比 0.35，95%CI 0.33-0.37，和 0.03，0.02-0.03）、女性（1.09，1.06-1.12，和 1.44，1.35-1.54）和吸烟者（1.36，1.28-1.43，和 1.71，1.53-1.91）、有药物滥用史（1.27，1.15-1.42，和 1.53，1.23-1.90）、视网膜病变（1.10，1.06-1.15，和 1.36，1.26-1.47）和胰岛素治疗（与无治疗相比；0.60，0.59-0.63，和 0.44，0.39-0.48）的患者中风险更低。对于低血糖，特别是黑种人（1.11，1.08-1.15）和有截肢史（1.20，1.13-1.27）的患者风险更高。
在这项针对糖尿病/ESKD 患者的全国性研究中，低血糖危象的发生率是高血糖危象的三倍，远高于慢性肾脏病非透析患者的全国报告。年轻、黑人和女性患者受到的影响不成比例。
