Temporal Trends of Severe Hypoglycemia and Subsequent Mortality in Patients with Advanced Diabetic Kidney Diseases Transitioning to Dialysis

Background: Patients with diabetic kidney disease (DKD) are at higher risk of hypoglycemia than diabetic patients without DKD. We aimed to investigate the temporal trends of severe hypoglycemia in advanced DKD patients transitioning to dialysis and examine risk factors associated with severe hypoglycemia. We also investigated the association of severe hypoglycemia episodes with one-year mortality after initiation of dialysis in patients with advanced DKD. Methods: Using the Taiwan National Health Insurance Research Database, 46,779 advanced DKD patients transitioning to dialysis (Peritoneal dialysis 4216, hemodialysis 42,563) between 1997 and 2011 were enrolled. We calculated the rates of severe hypoglycemia from 5 years before dialysis until 10 years after dialysis. Cox proportional hazard model was used to examine the risk factors of post end stage renal disease (ESRD) one-year hypoglycemia and post ESRD one-year mortality in advanced DKD patients transitioning to dialysis. Results: We found that 11.5% of advanced DKD patients had at least one episode of severe hypoglycemia the year leading up to dialysis initiation. Multivariate analysis revealed hemodialysis compared with peritoneal dialysis, stroke, use of sulfonylurea, glinide, and insulin were associated with higher risk of severe hypoglycemia one year after transitioning to dialysis. Increased frequency of severe hypoglycemia-related hospitalizations was associated with incrementally higher mortality risk one year after transitioning to dialysis (Pre-ESRD hypoglycemia: Hazard ratios: 1.28 (1.18–1.38, p < 0.001), 1.64 (1.49–1.81, p < 0.001) for one, two hypoglycemia-related hospitalizations, respectively; post-ESRD hypoglycemia: HRs of 1.56 (1.40–1.73, p < 0.001), 1.72 (1.39–2.12, p < 0.001) for one, two hypoglycemia-related hospitalizations, respectively (reference group: no hypoglycemia related hospitalization)). Conclusions: Among advanced DKD patients, we observed a progressive elevated risk of hypoglycemia during the critical dialysis transition period. Increased frequency of severe hypoglycemia-related hospitalizations was associated with higher mortality risk one year after transitioning to dialysis. Further study of glycemic management strategies which prevent hypoglycemia during the critical transition period are warranted.

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Abstract 11133: The Incidence and Predicting Factors of Heart Failure After First Acute Myocardial Infarction: A Population[[Unable to Display Character: ‐]]Based Study in Taiwan

Circulation ◽

10.1161/circ.130.suppl_2.11133 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Cheng-Han Lee ◽

Yi-Heng Li ◽

Ching-Lan Cheng ◽

Jyh-Hong Chen ◽

Yea-Huei Kao Yang

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Coronary Revascularization ◽

Temporal Trends ◽

Population Based ◽

Research Database ◽

Index Hospitalization ◽

Predicting Factors ◽

One Year

Background: Early coronary revascularization and medical therapy advancement improve the survival of patients (pts) with acute myocardial infarction (AMI). However, survivors of AMI are at heightened risk of developing heart failure (HF) and there is a paucity of information regarding this issue in Asian countries. This study described the temporal trends in the incidence of HF after the first AMI and the predicting factors of HF development in Taiwan. Methods: We conducted a nationwide population-based cohort study by using 1999 to 2009 National Health Insurance Research Database. Pts aged≧18 years, with no history of HF, who hospitalized with a first AMI between January 2002 and December 2008 were identified and followed up for one year. The primary outcome was HF. We evaluated the incidence of HF during the index hospitalization, 30 days, 6 months, and one year after the discharge. The predicting factors of HF were identified by Cox proportional hazard model. Results: Overall, 42,011 first AMI pts (mean age 64.4 ± 13.8 years; male 75.0%) from 2002 to 2008 were identified. The HF incidence during the index hospitalization was 14.8%. After exclusion of HF during the hospitalization, the overall HF prevalence at 30 days, 6 months, and 1 year was 9.6%, 14.2%, and 16.8%, respectively. The HF prevalence at 1 year declined from 17.9% to 14.9% (p<0.05) from 2002 to 2008. The independent predicting factors of HF after the first AMI were elder age (≧65 years) (adjusted HR 1.81, 95% CI 1.51-2.18), diabetes mellitus (adjusted HR 1.30, 95% CI 1.21-1.41), chronic kidney disease (adjusted HR 1.41, 95% CI 1.20-1.65), use of loop diuretics within 30 days after the discharge (adjusted HR 2.21, 95% CI 2.00-2.43), and recurrent AMI (adjusted HR 2.43, 2.16-2.74). Conclusions: Survivors of AMI without prior HF remain at risk of developing HF in Taiwan and most episodes occur within 6 months after AMI. Five important clinical factors of HF were identified that may help us for risk stratification.

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Risk Factors Responsible for Ultrafiltration Failure in Early Stages of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080002000609 ◽

2000 ◽

Vol 20 (6) ◽

pp. 631-636 ◽

Cited By ~ 17

Author(s):

Rafael Selgas ◽

M.-Auxiliadora Bajo ◽

M.-José Castro ◽

Gloria Del Peso ◽

Abelardo Aguilera ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Control Group ◽

Diabetic Patients ◽

Rapid Loss ◽

The Third ◽

Early Stages ◽

Ultrafiltration Failure ◽

Peritoneal Function ◽

Over Time

Objective To define risk factors for ultrafiltration failure (UFF) during early stages of peritoneal dialysis (PD). Design Retrospective analysis of a group of patients whose peritoneal function was prospectively followed. Setting A tertiary-care public university hospital. Patients Nineteen of 90 long-term PD patients required a peritoneal resting period to recover UF capacity: 8 had this requirement before the third year on PD (early, EUFF group) and 11 had a late requirement (LUFF group). The remaining 71 patients, those with stable peritoneal function over time, constituted the control group. Main Outcome Measures Peritoneal UF capacity under standard conditions (monthly) and small solute peritoneal transport (yearly). Results None of the conditions appearing at the start of PD or during the observation period could be definitely identified as the cause of UFF. There were no differences in characteristics between the EUFF group and the other two groups, except for the higher prevalence of diabetes in the EUFF group. Residual renal function (RRF) declined in all three groups during the first 2 years, with rapid loss during the third year in the EUFF group. This rapid loss in RRF was coincident with UFF. Peritoneal solute and water transport at baseline was similar in the three groups. After 2 years on PD, individuals in the EUFF group showed a significantly lower UF and higher creatinine mass transfer coefficient values than those in the LUFF group. Diabetic patients in the control group showed remarkable stability in UF capacity over time. During the second year on PD, requirement for increases in dialysate glucose concentration was 3.4 ± 0.5% in the LUFF group, but as high as 25.5 ± 24.2% in the EUFF group. The accumulated days of active peritonitis (APID, days with cloudy effluent) were similar for the three groups after 1, 2, and 3 years on PD. Interestingly, diabetic patients in the control group showed an APID index significantly lower than the overall EUFF group. Diabetics in the control group also had significantly lower APID versus nondiabetics in the control group ( p = 0.016). Conclusions Our findings suggest that certain patients develop early UFF type I. Diabetic state and a higher glucose requirement to obtain adequate UF suggest that glucose on both sides of the peritoneal membrane could be responsible. The mechanisms for this higher requirement remain to be elucidated. The identification of a larger cohort of these early UFF patients should lead to a better exploration of the primary pathogenic mechanisms.

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Management of the Diabetic Patients with End Stage Renal Disease

Peritoneal Dialysis International ◽

10.1177/089686088100201s01 ◽

1981 ◽

Vol 2 (1_suppl) ◽

pp. 6-10 ◽

Cited By ~ 1

Author(s):

Pablo Amair ◽

Ramesh Khanna ◽

Bernard Leibel ◽

Andreas Pierratos ◽

Stephen Vas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Intraperitoneal Administration ◽

Good Control ◽

Diabetic Patients ◽

Serum Triglycerides ◽

One Year ◽

Stage Renal Disease ◽

End Stage

Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar Even though creatinine clearance decreased significantly (P = 0.001), contro of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04 respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months a rate similar to that observed in nondiabetics. The calculated survival rate was 92 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent.

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Clinical presentation and mortality risk factors for COVID-19 among diabetic patients in a tertiary care center in South India

Indian Journal of Tuberculosis ◽

10.1016/j.ijtb.2021.08.015 ◽

2021 ◽

Author(s):

Yamini Marimuthu ◽

Radhika Kunnavil ◽

N. Satyanarana ◽

N.S. Anil ◽

Jeetendra Kumar ◽

...

Keyword(s):

Risk Factors ◽

Mortality Risk ◽

South India ◽

Clinical Presentation ◽

Care Center ◽

Tertiary Care ◽

Diabetic Patients ◽

Tertiary Care Center

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Risk Factors for Recurrent Hypoglycemia in Hospitalized Diabetic Patients Admitted for Severe Hypoglycemia

Yonsei Medical Journal ◽

10.3349/ymj.2010.51.3.367 ◽

2010 ◽

Vol 51 (3) ◽

pp. 367 ◽

Cited By ~ 28

Author(s):

Yen-Yue Lin ◽

Chin-Wang Hsu ◽

Wayne Huey-Herng Sheu ◽

Shi-Jye Chu ◽

Chin-Pyng Wu ◽

...

Keyword(s):

Risk Factors ◽

Severe Hypoglycemia ◽

Diabetic Patients ◽

Recurrent Hypoglycemia

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Identifying men at greatest risk of weight gain from androgen deprivation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.80 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 80-80

Author(s):

Daniel Martin Seible ◽

Xiangmei Gu ◽

Andrew Hyatt ◽

Clair Beard ◽

Jason Alexander Efstathiou ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Weight Gain ◽

Androgen Deprivation Therapy ◽

Weight Change ◽

Androgen Deprivation ◽

Baseline Risk ◽

Diabetic Patients ◽

Diabetic Status ◽

One Year

80 Background: Androgen deprivation therapy (ADT) is a mainstay of prostate cancer therapy. Weight gain is among the adverse metabolic changes associated with ADT, and may contribute to cardiovascular comorbidity. A better understanding of the risk factors for weight gain on ADT is important for optimal management of ADT-associated morbidity. Methods: A retrospective review assessed weight change among 118 men with nonmetastatic prostate cancer treated with ADT. The primary endpoint was weight change at one year from ADT initiation, with the secondary aim to stratify risk of weight gain by baseline patient characteristics. Statistical analyses were performed using two-tailed t-tests and linear regression. Results: Men in our cohort exhibited a significant increase in weight (p=0.0005) in the one year following ADT initiation. Three risk factors for weight gain on ADT were identified: younger than age 65 (5.98 pounds gained, p=0.001 vs. 1.63 pounds, p= 0.09 for age 65+), body mass index (BMI) less than 30 (4.36 pounds gained, p=0.00002 vs. 0.22 pounds, p=0.87 for BMI 30+), and non-diabetic status (3.43 pounds gained, p=0.0003 vs. 0.57 pounds, p=0.74 for diabetics). An aggregate risk scoring system was contrived to allow for weight change prediction by total number of risk factors present: scores of 0, 1, 2, and 3 risk factors corresponded to weight changes of -2.42 (p=0.43), +0.9 (p=0.56), +2.9 (p=0.01) and +8.3 pounds (p= 0.0001) respectively. Weight gain increased significantly with increasing risk score (p-trend= 0.0005), decreasing baseline age (p-trend= 0.004) and decreasing baseline BMI (p-trend= 0.01). Conclusions: Younger than age 65, BMI less than 30, and non-diabetic status were each significantly associated with weight gain one year after starting ADT. Increasing weight gain was strongly associated with increasing number of baseline risk factors. Although metabolic consequences were previously considered most significant for patients with preexisting comorbidity, these data suggest younger, slimmer, and non-diabetic patients may be at higher risk for gaining weight on ADT. As these three categories of men generally have higher endogenous testosterone (T) levels prior to ADT compared to older, obese, and diabetic men, the magnitude of T decline following ADT might explain these findings.

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Risk Factors and Clinical Outcomes of Cognitive Impairment in Diabetic Patients Undergoing Peritoneal Dialysis

Kidney & Blood Pressure Research ◽

10.1159/000514172 ◽

2021 ◽

pp. 1-10

Author(s):

Xuan Huang ◽

Chunyan Yi ◽

Meiju Wu ◽

Yagui Qiu ◽

Haishan Wu ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Demographic Data ◽

Diabetic Patients ◽

Lower Survival Rate ◽

Technique Survival ◽

Risk Of Mortality ◽

Patients With Diabetes

Introduction: Cognitive impairment (CI) is common in patients with CKD or diabetes mellitus (DM). However, the relevance between DM and CI in diabetic patients undergoing peritoneal dialysis (PD) has not been clearly established. This study aimed to explore the role of DM in CI, the association of glycemic control with CI, and clinical outcomes of CI in diabetic PD patients. Methods: Continuous ambulatory PD (CAPD) patients followed up in our PD center between 2014 and 2016 were enrolled. The participants were followed until an endpoint was reached or December 2017. Demographic data and clinical characteristics were collected, and laboratory parameters were measured. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function, and a score of <26 was considered to indicate CI. A propensity score matching according to age, gender, and mean arterial pressure was conducted between the DM and non-DM groups. Results: A total of 913 CAPD patients were enrolled, of whom 186 (20.4%) had diabetes. After appropriate matching, 175 patients in the DM group and 270 patients in the non-DM group were included. Patients with diabetes had a higher prevalence of CI and lower scores for visuospatial/executive function, naming, language, delayed recall, and orientation. Higher HbA1c (odds ratio [OR], 1.547; 95% confidence interval [95% CI], 1.013–2.362) and cardiovascular disease (CVD; OR, 2.926; 95% CI, 1.139–7.516) significantly correlated with a risk of CI in diabetic patients. During a median of 26.0 (interquartile range 13.5–35.6) months of follow-up, diabetic patients with CI demonstrated a significantly lower survival rate than those without CI, and CI was an independent risk factor for mortality after adjustment (hazard ratio, 7.224; 95% CI, 1.694–30.806). However, they did not show worse technique survival or higher peritonitis rate than patients without CI. Conclusions: HbA1c and CVD are independent risk factors for CI in diabetic patients undergoing CAPD, and CI is independently associated with a higher risk of mortality.

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The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00139 ◽

2015 ◽

Vol 35 (3) ◽

pp. 351-359 ◽

Cited By ~ 17

Author(s):

Shang-Feng Yang ◽

Chia-Jen Liu ◽

Wu-Chang Yang ◽

Chao-Fu Chang ◽

Chih-Yu Yang ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Protective Factor ◽

Female Gender ◽

Population Based ◽

Chronic Obstructive ◽

Research Database ◽

Hernia Formation ◽

History Of ◽

The Impact

ObjectivesThere is a lack of consensus on the risk factors for hernia formation, and the impact on peritoneal dialysis (PD) survival has seldom been studied.MethodsThis was a population-based study and all collected data were retrieved from the National Health Insurance Research Database of Taiwan. Patients who commenced PD between January 1998 and December 2006 were screened for inclusion. Multiple logistic regression and Cox proportional hazards models were applied to estimate the predictors for hernia formation and determine the predictors of PD withdrawal.ResultsA total of 6,928 PD patients were enrolled and followed until December 2009, with 631 hernia events and 391 hernioplasties being registered in 530 patients (7.7%). The incidence rate was 0.04 hernias/patient/year. Longer PD duration (per 1 month increase, hazard ratio (HR) 1.019) and history of mitral valve prolapse (MVP) (HR 1.584) were independent risk factors for hernia formation during PD, and female gender (HR 0.617) was a protective factor. On the other hand, there were 4,468 PD withdrawals, with cumulative incidence rates of 41% at 1 year, 66% at 3 years, and 82% at 5 years. Independent determinants for cumulative PD withdrawal included hernia formation during PD (HR 1.154), age (per 1 year increase, HR 1.014), larger dialysate volume (per 1 liter increase, HR 0.496), female gender (HR 0.763), heart failure (HR 1.092), hypertension (HR 1.207), myocardial infarction (HR 1.292), chronic obstructive pulmonary disease (COPD) (HR 1.227), cerebrovascular accident (CVA) (HR 1.364), and history of MVP (HR 0.712)ConclusionsProlonged PD duration was a risk factor for hernia formation, and female gender was protective. Hernia formation during PD therapy may increase the risk of PD withdrawal.

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