Non-recovery acute kidney injury and additional risk factors for short-term and long-term hypoglycemia: A multi-institutional cohort study

Jia-Jin Chen; Ming-Jen Chan; Pei-Chun Fan; Tsung-Yu Tsai; Chieh-Li Yen; Ching-Chung Hsiao; Cheng-Chia Lee; Chia-Hung Lin; Yung-Chang Chen; Chih-Wei Yang; Chih-Hsiang Chang

doi:10.1016/j.jfma.2024.12.007

Non-recovery acute kidney injury and additional risk factors for short-term and long-term hypoglycemia: A multi-institutional cohort study

J Formos Med Assoc. 2024 Dec 10:S0929-6646(24)00566-7. doi: 10.1016/j.jfma.2024.12.007. Online ahead of print.

Authors

Affiliations

¹ Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
² Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
³ Department of Nephrology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: [email protected].

PMID: 39665938
DOI: 10.1016/j.jfma.2024.12.007

Abstract

Background: Acute kidney injury (AKI) is associated with increased in-hospital and short-term hypoglycemia risk. However, the impact of non-recovery of renal function before discharge on hypoglycemia risk in AKI survivors after discharge have not been well studied. We aim to analyze the association between non-recovery of AKI and hypoglycemia, hyperglycemia crisis risk, to identify additional risk factors for hypoglycemia, and to examine the impact of AKI non-recovery on HbA1c variability.

Methods: This multi-institutional retrospective cohort study based on Chang Gung Research Database included type 2 diabetes patients with first admission for AKI. Participants were categorized into renal recovery or non-recovery groups. Hypoglycemia, hyperglycemia crisis, new insulin use, re-AKI admission, all-cause mortality and HbA1c variability within 2 years after discharge were assessed. IPTW was used for covariate balance.

Results: A total of 16,796 participants were enrolled. AKI non-recovery was associated with increased higher hypoglycemia risk (HR: 1.19; 95% CI: 1.11-1.28), increased new insulin prescriptions (HR: 1.21; 95% CI: 1.14-1.27), and lower mean HbA1c levels compared to the recovery group. Subgroup analysis showed higher hypoglycemia risk in the non-recovery group with post-AKI anemia/hypoalbuminemia status (HR: 1.39; 95% CI: 1.23-1.55). De novo CKD development in AKI non-recovery group was a protective factor for hyperglycemia crisis (HR: 0.77; 95% CI: 0.69-0.87).

Conclusions: Non-recovery AKI is associated with an increased risk of hypoglycemia, regardless of whether de novo CKD develops, and is linked to lower mean A1c level within two-years post-discharge. Identifying high-risk individuals for post-AKI hypoglycemia is vital for optimal patient care.