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Am J Kidney Dis. 2017 Jul;70(1):59-68. doi: 10.1053/j.ajkd.2016.11.019. Epub 2017 Jan 27.

Hypoglycemia Incidence in Older Adults by Estimated GFR.

Author information

1
School of Health Studies, Western University, London, Ontario, Canada.
2
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
3
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
4
Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
5
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ontario, Canada. Electronic address: kristin.clemens@sjhc.london.on.ca.

Abstract

BACKGROUND:

Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful.

STUDY DESIGN:

Population-based cohort study.

SETTING & PARTICIPANTS:

Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013.

FACTORS:

eGFR stage, ACR stage, and use of antihyperglycemic medications.

OUTCOME:

3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter).

RESULTS:

In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2 or the patient was receiving dialysis, respectively (P<0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P<0.001). A similar relationship was evident by eGFR and ACR risk category.

LIMITATIONS:

Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients.

CONCLUSIONS:

In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.

KEYWORDS:

Hypoglycemia; antihyperglycemic medications; elderly; epidemiology; estimated glomerular filtration rate (eGFR); glycated hemoglobin (HbA(1c)); hospital encounter; kidney disease; older adults; outcomes; renal function; urinary albumin-creatinine ratio (UACR)

PMID:
28139395
DOI:
10.1053/j.ajkd.2016.11.019
[Indexed for MEDLINE]

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