Association of Hypoglycemia With Incident Chronic Kidney Disease in Patients With Type 2 Diabetes: A Nationwide Population-Based Study

This article aims to investigate the long-term risk of incident chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients with hypoglycemia. This nationwide, population-based, propensity score (PS)-matched cohort study involved 2 cohorts: a hypoglycemic cohort and a matched cohort without hypoglycemia. Data from 1.3 million patients with newly diagnosed T2DM between 2000 and 2010 were extracted from Taiwan's National Health Insurance Research Database. Hypoglycemic events were collected using inpatient, outpatient, and emergency department diagnoses. Patients aged <20 years and those with previous histories of CKD were excluded. The association between hypoglycemia and subsequent CKD risk in patients with T2DM was examined using Cox regression analysis after PS matching. During the mean follow-up period of 4.2 years, a total of 15,036 (1.7 %) patients experienced at least 1 episode of hypoglycemia and 15,036 matched controls without hypoglycemia were identified among 906,368 eligible patients. The incidence rates of subsequent CKD were 26.1 and 14.8 events per 1000 person-years in the hypoglycemic and matched cohorts, respectively. The hazard ratio (HR) of hypoglycemia for incident CKD was 1.77 (95% confidence interval [CI], 1.63–1.92; P < 0.001). Compared with those without hypoglycemia, HRs for 1 to 3 and ≥4 episodes of hypoglycemia for CKD were 1.65 (95% CI, 1.50–1.81) and 1.75 (95% CI, 1.34–2.29), respectively (P for trend <0.001). Our study supports the association of hypoglycemia with CKD development among patients with T2DM, possibly in a dose-dependent relationship.