Dangerously high or low blood glucose levels are much more common in people with end-stage kidney disease — chronic kidney disease that requires dialysis — than in people with diabetes with earlier stages of chronic kidney disease, according to a new study published in the journal Diabetes Care.
Chronic kidney disease is a common complication of diabetes, and diabetes is a leading cause of kidney disease worldwide. Kidney problems typically develop in people with diabetes when high blood glucose, over time, damages and destroys the tiny blood vessels within the filtering units of the kidneys (nephrons). Once enough nephrons are no longer working, the kidneys lose their ability to effectively remove waste products from the blood and pass them into urine (which the kidneys produce). In end-stage kidney disease, a person’s kidneys have lost so much function that survival depends on artificial filtering of waste products from the blood. This is done through dialysis, in which (most commonly) a machine is used to filter someone’s blood and return it to the body, typically over a period of several hours three times each week.
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For the latest study, researchers looked at data from 521,789 adults in the United States with both diabetes and end-stage kidney disease. They set out to evaluate the frequency of emergency room visits or hospitalizations for very high or low blood glucose, after adjusting for factors like age, sex, race or ethnicity, dialysis modality (either standard hemodialysis, or a less common method called peritoneal dialysis), other health conditions, and the U.S. region where participants lived. The median age of participants was 65, and about 56% of them were men.
Hypoglycemic and hyperglycemic crises in end-stage kidney disease
After adjusting for the factors listed above, the researchers found that the rate of hypoglycemic (low blood glucose) crises was 53.6 per 1,000 person-years, while the rate of hyperglycemic (high blood glucose) crises was 18.2 per 1,000 person-years — only about one-third as common. Perhaps surprisingly, the risk for these dangerous events declined with age — older participants were the least likely to experience them, with participants ages 75 and older 65% less likely to have a hypoglycemic crisis and 97% less likely to have a hyperglycemic crisis than those ages 18 to 44. Factors that were linked to a higher risk for a hypoglycemic crisis included being a woman (9% higher risk), smoking (36% higher risk), substance abuse (27% higher risk), having diabetic retinopathy (10% higher risk), being Black (11% higher risk), and a prior amputation (20% higher risk), while taking insulin was linked to a 40% lower risk compared with those who didn’t take insulin.
Factors that were linked to a higher risk for a hyperglycemic crisis included being a woman (44% higher risk), smoking (71% higher risk), substance abuse (53% higher risk), and having diabetic retinopathy (36% higher risk), while taking insulin was linked to a 56% lower risk compared with those who didn’t take insulin.
The researchers noted that the rate of hypoglycemic crises seen in this study are much greater than what past studies have found in people with earlier stages of chronic kidney disease that don’t require dialysis. This could mean that progressing to end-stage kidney disease has harmful effects on blood glucose control — or that people who experience severe hypoglycemia are more likely to see their kidney disease progress. Either way, it appears that people with end-stage kidney disease stand to benefit from precautionary measures like wearing a continuous glucose monitoring (CGM) device that can detect when blood glucose is low before it falls into crisis territory. The researchers also pointed out that based on their results, younger, female, and Black people with end-stage kidney disease are especially likely to have the kinds of blood glucose crises that CGM could help prevent.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
