We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabetes and end-stage kidney disease (ESKD).

This was a nationwide, retrospective study of adults (≥18 years old) with diabetes/ESKD, from the United States Renal Data System registry, between 2013 and 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1,000 person-years. Event rates and risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality, comorbidities, treatment regimen, and U.S. region.

Among 521,789 adults with diabetes/ESKD (median age 65 years [interquartile range 57–73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1,000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, respectively, the risks decreased with age and were lowest in older patients (≥75 vs. 18–44 years old: incidence rate ratio 0.35, 95% CI 0.33–0.37, and 0.03, 0.02–0.03), women (1.09, 1.06–1.12, and 1.44, 1.35–1.54), and those with smoking (1.36, 1.28–1.43, and 1.71, 1.53–1.91), substance abuse (1.27, 1.15–1.42, and 1.53, 1.23–1.9), retinopathy (1.10, 1.06–1.15, and 1.36, 1.26–1.47), and insulin therapy (vs. no therapy; 0.60, 0.59–0.63, and 0.44, 0.39–0.48). For hypoglycemia, specifically, additional risk was conferred by Black race (1.11, 1.08–1.15) and amputation history (1.20, 1.13–1.27).

In this nationwide study of patients with diabetes/ESKD, hypoglycemic crises were threefold more common than hyperglycemic crises, greatly exceeding national reports in nondialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected.

我们描述了糖尿病和终末期肾病 (ESKD) 患者严重低血糖和高血糖危象（糖尿病酮症酸中毒/高血糖高渗状态）的年度趋势。

这是一项针对 2013 年至 2017 年美国肾脏数据系统登记处患有糖尿病/ESKD 的成人（≥18 岁）的全国性回顾性研究。主要结果是每年因低血糖和高血糖危机就诊或住院的急诊率，报告为事件数/1,000 人年。事件发生率和危险因素根据患者年龄、性别、种族/民族、透析方式、合并症、治疗方案和美国地区进行了调整。

在 521,789 名患有糖尿病/ESKD 的成年人中（中位年龄 65 岁 [四分位间距 57–73]，男性占 56.1%，白人占 46%），调整后的低血糖和高血糖危象发生率分别为每 1,000 人年 53.64 次和 18.24 次。对于低血糖和高血糖危象，风险随着年龄的增长而降低，并且在老年患者中风险最低（≥75 岁与 18-44 岁：发生率比 0.35，95% CI 0.33-0.37，和 0.03，0.02-0.03） 、女性（1.09、1.06–1.12 和 1.44、1.35–1.54）以及吸烟者（1.36、1.28–1.43 和 1.71、1.53–1.91）、药物滥用者（1.27、1.15–1.42 和 1.53、1.23– 1.9）、视网膜病变（1.10、1.06–1.15 和 1.36、1.26–1.47）和胰岛素治疗（与不治疗相比；0.60、0.59–0.63 和 0.44、0.39–0.48）。具体而言，对于低血糖症，黑人种族赋予了额外的风险 (1.11, 1.08–1.

在这项针对糖尿病/ESKD 患者的全国性研究中，低血糖危象的发生率是高血糖危象的三倍，大大超过了慢性肾病非透析患者的国家报告。年轻、黑人和女性患者受到的影响尤为严重。