Department of Nephrology, Fukui-ken Saiseikai Hospital, Fukui, Japan.
Department of Endocrinology, Diabetes and Metabolism, Fukui-ken Saiseikai Hospital, Fukui, Japan.
Clin J Am Soc Nephrol. 2023 Apr 1;18(4):475-484. doi: 10.2215/CJN.0000000000000102. Epub 2023 Mar 3.
Hypoglycemia represents a risk for serious morbidity. We evaluated the prevalence and risk factors of hypoglycemia by continuous glucose monitoring (CGM) in patients with CKD with or without diabetes.
In this cross-sectional study, outpatients with CKD stages G3-G5 (including hemodialysis) and type 2 diabetes without CKD were enrolled and underwent intermittently scanned CGM measurements for 7 days. The burden of CGM-measured hypoglycemia was assessed using the 7-day sum of area over the curve with glucose levels <70 mg/dl and the sum of time spent <54 mg/dl.
A total of 366 participants (148 participants with CKD and diabetes, 115 with CKD and without diabetes, and 103 without CKD and with diabetes) were included. Glucose levels of <54 mg/dl were observed in 41% of participants with CKD and diabetes, 48% of participants with CKD and without diabetes, and 14% of participants with diabetes and without CKD. However, only two participants reported hypoglycemic symptoms during CGM measurements, which were confirmed and documented by capillary blood glucose measurements. Between-group differences of 7-day area over the curve (<70 mg/dl) were as follows: hemodialysis group versus CKD stage G4 and G5 groups, -0.25 min·mg/dl per hour (95% confidence interval [CI], -6.40 to -0.59) P <0.001; CKD stage G4 and G5 groups versus CKD stage G3 group, -0.08 min·mg/dl per hour (95% CI, -0.0 to -0.50) P =0.15; and CKD stage G3 group versus diabetes without CKD group, -0.14 min·mg/dl per hour (95% CI, -0.0 to -0.20) P =0.01. In addition, the subgroup analysis of the diabetic or nondiabetic and at daytime or nighttime showed that the 7-day area over the curve (<70 mg/dl) and time spent (<54 mg/dl) was larger with worse kidney function.
The lowering level of kidney function was strongly associated with the burden of hypoglycemia in patients with CKD.
低血糖会导致严重的发病率。我们通过连续血糖监测（CGM）评估了伴有或不伴有糖尿病的 CKD 患者的低血糖发生率和危险因素。
在这项横断面研究中，招募了 CKD 3-5 期（包括血液透析）和无 CKD 的 2 型糖尿病患者，并进行了为期 7 天的间歇性扫描 CGM 测量。通过 7 天的曲线下面积总和（血糖水平 <70mg/dl）和时间总和（<54mg/dl）来评估 CGM 测量的低血糖负担。
共纳入 366 名参与者（148 名 CKD 合并糖尿病患者、115 名 CKD 不合并糖尿病患者和 103 名无 CKD 合并糖尿病患者）。41%的 CKD 合并糖尿病患者、48%的 CKD 不合并糖尿病患者和 14%的无 CKD 合并糖尿病患者的血糖水平<54mg/dl。然而，只有两名参与者在 CGM 测量期间报告了低血糖症状，这些症状通过毛细血管血糖测量得到证实和记录。7 天曲线下面积（<70mg/dl）的组间差异如下：血液透析组与 CKD 4 期和 5 期组相比，-0.25min·mg/dl/小时（95%置信区间[-6.40，-0.59]）P<0.001；CKD 4 期和 5 期组与 CKD 3 期组相比，-0.08min·mg/dl/小时（95%置信区间[-0.0，-0.50]）P=0.15；CKD 3 期组与无 CKD 的糖尿病组相比，-0.14min·mg/dl/小时（95%置信区间[-0.0，-0.20]）P=0.01。此外，糖尿病或非糖尿病以及白天或夜间的亚组分析表明，随着肾功能恶化，7 天曲线下面积（<70mg/dl）和时间（<54mg/dl）的范围更大。
肾功能下降与 CKD 患者的低血糖负担密切相关。
