Endocrine Abstracts

Introduction: Acute Kidney Injury (AKI) is highly prevalent during hospitalization of patients with type 2 diabetes (T2D), and has been associated with increased risk of hypoglycaemia in Intensive Care Units. However, this association in non-critically ill patients is less clear and evidence on the impact of AKI’s severity and duration on hypoglycaemia is lacking.

Objectives: To assess the impact of AKI and its severity and duration on the risk of hypoglycaemia during hospitalization of non-critically ill patients with T2D.

Methods: Retrospective cohort study of patients with T2D, hospitalized in Internal Medicine wards, from 01/01/2018 to 31/12/2019. AKI was defined as an increase in serum creatinine by ≥0.3 mg/dl in 48 hours or ≥1.5 times baseline within 7 days, and hypoglycaemia as blood glucose concentration <70mg/dl. Glomerular filtration rate (GFR) was calculated by CKD-EPI equation and patients with chronic kidney disease (CKD) stage ≥4 were excluded. 239 hospitalizations with AKI were obtained (Group 1) and an equivalent number without AKI was randomly selected (Group 2). Binary logistic regression was used to control for confounding factors and ROC curve analysis to determine cut-off values for AKI’s duration.

Results: 478 cases were analysed, with mean HbA1C of 7.4±1.6%, 36.0% previously treated with insulin. Patients with AKI were older (82.7±7.9 vs 80.3±10.1 years, P=0.004) and had lower basal GFR (59.0±17.3 vs 70.7±19.1, P<0.001). The prevalence of hypoglycaemia was higher in Group 1 (40.2% vs 15.9%, P<0.001) and the risk increase was sustained when adjusted for confounding factors (including previous insulin therapy and insulin therapy protocol during hospitalization), with a 4.5 times greater risk of hypoglycaemia in the presence of AKI (95%CI: 1.9-10.3). AKI’s severity was associated with mortality but not with hypoglycaemia. In contrast, each day of AKI’s duration was associated with an increase of 15% on the risk of hypoglycaemia and 16% on the risk of 30-day mortality, independently of its severity. A cut-off of 5.5 days of AKI was obtained for increased risk of hypoglycaemia and mortality. Globally, patients with hypoglycaemia had 4.4 times greater risk of death in 30 days (95%CI: 2.4-8.1).

Conclusion: AKI was an important risk factor for hypoglycaemia in non-critically ill hospitalized patients with T2D, and its prevalence was superior in elderly patients with CKD. The duration of AKI was the main factor increasing the risk of hypoglycaemia and mortality. These results highlight the need to define specific protocols to avoid hypoglycaemia and its burden in patients with AKI.