<b>Objective</b>: We characterized annual
trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic
hyperosmolar state) in patients with diabetes and end-stage kidney disease (DM/ESKD).
<p> </p>
<p><b>Design</b>: Nationwide,
retrospective study of adults (≥18 years) with DM/ESKD, from the United States Renal Data System
registry, 2013 to 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1000 person-years. Adjusted event rates and
risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality,
comorbidities, treatment regimen and U.S. region.</p>
<p> </p>
<p><b>Results</b>: Among
521,789 adults with DM/ESKD (median age 65 years [IQR 57-73], 56.1% male, and
46% White), overall
adjusted rates of hypoglycemic and hyperglycemic crises
were 53.64 and 18.24 per 1000 person-years, respectively. For both hypoglycemia and hyperglycemia crises,
the risks decreased with age and were lowest in older patients (≥75 vs 18-44 years: IRR 0.35 [95% CI 0.33-0.37]
and 0.03 [0.02-0.03], women (IRR 1.09 [1.06-1.12] and 1.44 [1.35-1.54]),
and with smoking (IRR 1.36 [1.28-1.43] and 1.71 [1.53-1.91]), substance abuse
(IRR 1.27 [1.15-1.42] and 1.53 [1.23-1.9]), retinopathy (IRR 1.10 [1.06-1.15]
and 1.36 [1.26-1.47]), and insulin therapy (vs. no therapy; IRR 0.60 [0.59-0.63] and 0.44 [0.39-0.48]), respectively.
For hypoglycemia, specifically, additional risk was conferred by Black
race (IRR 1.11 [1.08-1.15]) and amputation history (IRR 1.20 [1.13-1.27]).</p>
<p> </p>
<p><b>Conclusions</b>: In this nationwide study of patients with DM/ESKD,
hypoglycemic crises were three-fold more common than hyperglycemic crises, greatly exceeding national reports in non-dialysis patients with chronic
kidney disease. Young, Black, and female patients were disproportionately
affected. </p>
Combining Population Health and Baseline Risk Strategy by Determining an Age Cutoff for Initiating Statins in Patients With Diabetes: A population-based study
