OBJECTIVE Hypoglycemia is common in patients with diabetes. The risk of hypoglycemia after acute kidney injury (AKI) is not well defined. The purpose of this study was to compare the risk for postdischarge hypoglycemia among hospitalized patients with diabetes who do and do not experience AKI.

RESEARCH DESIGN AND METHODS We performed a propensity-matched analysis of patients with diabetes, with and without AKI, using a retrospective national cohort of veterans hospitalized between 2004 and 2012. AKI was defined as a 0.3 mg/dL or 50% increase in serum creatinine from baseline to peak serum creatinine during hospitalization. Hypoglycemia was defined as hospital admission or an emergency department visit for hypoglycemia or as an outpatient blood glucose <60 mg/dL. Time to incident hypoglycemia within 90 days postdischarge was examined using Cox proportional hazards models. Prespecified subgroup analyses by renal recovery, baseline chronic kidney disease, preadmission drug regimen, and HbA_1c were performed.

RESULTS We identified 65,151 propensity score–matched pairs with and without AKI. The incidence of hypoglycemia was 29.6 (95% CI 28.9–30.4) and 23.5 (95% CI 22.9–24.2) per 100 person-years for patients with and without AKI, respectively. After adjustment, AKI was associated with a 27% increased risk of hypoglycemia (hazard ratio [HR] 1.27 [95% CI 1.22–1.33]). For patients with full recovery, the HR was 1.18 (95% CI 1.12–1.25); for partial recovery, the HR was 1.30 (95% CI 1.23–1.37); and for no recovery, the HR was 1.48 (95% CI 1.36–1.60) compared with patients without AKI. Across all antidiabetes drug regimens, patients with AKI experienced hypoglycemia more frequently than patients without AKI, though the incidence of hypoglycemia was highest among insulin users, followed by glyburide and glipizide users, respectively.

CONCLUSIONS AKI is a risk factor for hypoglycemia in the postdischarge period. Studies to identify risk-reduction strategies in this population are warranted.

目的低血糖在糖尿病患者中很常见。急性肾损伤（AKI）后发生低血糖的风险尚不明确。本研究的目的是比较发生和未发生 AKI 的住院糖尿病患者发生出院后低血糖的风险。

研究设计和方法我们使用 2004 年至 2012 年间住院退伍军人的全国回顾性队列，对患有或不患有 AKI 的糖尿病患者进行了倾向匹配分析。AKI 的定义是血清肌酐增加 0.3 mg/dL 或增加 50%住院期间从基线到峰值血清肌酐。低血糖定义为因低血糖入院或急诊室就诊或门诊血糖<60 mg/dL。使用 Cox 比例风险模型检查出院后 90 天内发生低血糖的时间。根据肾脏恢复情况、基线慢性肾脏病、入院前药物治疗方案和 HbA _1c进行预先指定的亚组分析。

结果我们确定了 65,151 组倾向得分匹配的患有和不患有 AKI 的配对。对于患有和不患有 AKI 的患者，低血糖发生率分别为每 100 人年 29.6 例（95% CI 28.9–30.4）和 23.5 例（95% CI 22.9–24.2）。调整后，AKI 与低血糖风险增加 27% 相关（风险比 [HR] 1.27 [95% CI 1.22–1.33]）。对于完全康复的患者，HR 为 1.18（95% CI 1.12-1.25）；对于部分恢复，HR 为 1.30 (95% CI 1.23–1.37)；对于未恢复的患者，与无 AKI 的患者相比，HR 为 1.48（95% CI 1.36-1.60）。在所有抗糖尿病药物治疗方案中，患有 AKI 的患者比未患 AKI 的患者更频繁地发生低血糖，尽管低血糖发生率在胰岛素使用者中最高，其次是格列本脲和格列吡嗪使用者。

结论AKI 是出院后低血糖的危险因素。有必要进行研究以确定该人群的风险降低策略。