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Association of hyperglycemic crisis with an increased risk of end-stage renal disease: A nationwide population-based cohort study

  • Yuan Kao
    Affiliations
    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
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  • I-Jung Feng
    Affiliations
    Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
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  • Chien-Chin Hsu
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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  • Jhi-Joung Wang
    Affiliations
    Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
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  • Hung-Jung Lin
    Correspondence
    Corresponding authors at: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
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  • Chien-Cheng Huang
    Correspondence
    Corresponding authors at: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
    Affiliations
    Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

    Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
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Published:February 03, 2018DOI:https://doi.org/10.1016/j.diabres.2018.01.008

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

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      References

      1. National Kidney Foundation. Diabetes. Accessed from https://www.kidney.org/atoz/atozTopic_Diabetes on July 4, 2017.

        • Hahr A.J.
        • Molitch M.E.
        Management of diabetes mellitus in patients with chronic kidney disease.
        Clin Diabetes Endocrinol. 2015; 1: 2
        • Huang C.C.
        • Weng S.F.
        • Tsai K.T.
        • Chen P.J.
        • Lin H.J.
        • Wang J.J.
        • et al.
        Long-term mortality risk after hyperglycemic crisis episodes in geriatric patients with diabetes: a national population-based cohort study.
        Diabetes Care. 2015; 38: 746-751
        • Kao Y.
        • Hsu C.C.
        • Weng S.F.
        • Lin H.J.
        • Wang J.J.
        • Su S.B.
        • et al.
        Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study.
        Endocrine. 2016; 51: 72-82
        • Huang C.C.
        • Kuo S.C.
        • Chien T.W.
        • Lin H.J.
        • Guo H.R.
        • Chen W.L.
        • et al.
        Predicting the hyperglycemic crisis death (PHD) Score: a new decision rule for emergency and critical care.
        Am J Emerg Med. 2013; 31: 830-834
        • Huang C.C.
        • Chien T.W.
        • Su S.B.
        • Guo H.R.
        • Chen W.L.
        • Chen J.H.
        • et al.
        Infection, absent tachycardia, cancer history, and severe coma are independent mortality predictors in geriatric patients with hyperglycemic crises.
        Diabetes Care. 2013; 36: e151-e152
        • Huang C.C.
        • Lin H.J.
        • Chen S.C.
        • Kuo S.C.
        • Chen W.L.
        • Chen J.H.
        • et al.
        Cancer history, bandemia, and serum creatinine are independent mortality predictors in patients with infection-precipitated hyperglycemic crises.
        BMC Endocr Disord. 2013; 13: 23
        • Chou Willy
        • Chung M.H.
        • Wang H.Y.
        • Chen J.H.
        • Chen W.L.
        • Guo H.R.
        • et al.
        Clinical characteristics of hyperglycemic crises in patients without a history of diabetes.
        J Diabetes Investig. 2014; 5: 657-662
      2. National Kidney Foundation. KDOQI GUIDELINES. Accessed from http://kidneyfoundation.cachefly.net/professionals/KDOQI/guidelines_ckd/p4_class_g1.htm on July 4, 2017.

      3. National Health Insurance Research Database. Background. Accessed from https://nhird.nhri.org.tw/en/index.html on July 4, 2017.

        • Mehta R.L.
        Glycemic control and critical illness: is the kidney involved?.
        J Am Soc Nephrol. 2007; 18: 2623-2627
        • Rady M.Y.
        • Johnson D.J.
        • Patel B.M.
        • Larson J.S.
        • Helmers R.A.
        Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus.
        Mayo Clin Proc. 2005; 80: 1558-1567
        • Van den Berghe G.
        • Wilmer A.
        • Hermans G.
        • Meersseman W.
        • Wouters P.J.
        • Milants I.
        • et al.
        Intensive insulin therapy in the medical ICU.
        N Engl J Med. 2006; 354: 449-461
        • Frankenfield D.C.
        • Reynolds H.N.
        Nutritional effect of continuous hemodiafiltration.
        Nutrition. 1995; 11: 388-393
        • Vanhorebeek I.
        • Langouche L.
        • Van den Berghe G.
        Glycemic and nonglycemic effects of insulin: how do they contribute to a better outcome of critical illness?.
        Curr Opin Crit Care. 2005; 11: 304-311
        • Adler A.
        • Casula A.
        • Steenkamp R.
        • Fogarty D.
        • Wilkie M.
        • Tomlinson L.
        • et al.
        Association between glycemia and mortality in diabetic individuals on renal replacement therapy in the UK.
        Diabetes Care. 2014; 37: 1304-1311
        • Kazancioğlu R.
        Risk factors for chronic kidney disease: an update.
        Kidney Int Suppl. 2011; 2013: 368-371
        • Singh P.
        • Rifkin D.E.
        • Blantz R.C.
        Chronic kidney disease: an inherent risk factor for acute kidney injury?.
        Clin J Am Soc Nephrol. 2010; 5: 1690-1695