Non-recovery acute kidney injury and additional risk factors for short-term and long-term hypoglycemia: A multi-institutional cohort study

Background: Acute kidney injury (AKI) is associated with increased in-hospital and short-term hypoglycemia risk. However, the impact of non-recovery of renal function before discharge on hypoglycemia risk in AKI survivors after discharge have not been well studied. We aim to analyze the association between non-recovery of AKI and hypoglycemia, hyperglycemia crisis risk, to identify additional risk factors for hypoglycemia, and to examine the impact of AKI non-recovery on HbA1c variability. Methods: This multi-institutional retrospective cohort study based on Chang Gung Research Database included type 2 diabetes patients with first admission for AKI. Participants were categorized into renal recovery or non-recovery groups. Hypoglycemia, hyperglycemia crisis, new insulin use, re-AKI admission, all-cause mortality and HbA1c variability within 2 years after discharge were assessed. IPTW was used for covariate balance. Results: A total of 16,796 participants were enrolled. AKI non-recovery was associated with increased higher hypoglycemia risk (HR: 1.19; 95% CI: 1.11–1.28), increased new insulin prescriptions (HR: 1.21; 95% CI: 1.14–1.27), and lower mean HbA1c levels compared to the recovery group. Subgroup analysis showed higher hypoglycemia risk in the non-recovery group with post-AKI anemia/hypoalbuminemia status (HR: 1.39; 95% CI: 1.23–1.55). De novo CKD development in AKI non-recovery group was a protective factor for hyperglycemia crisis (HR: 0.77; 95% CI: 0.69–0.87). Conclusion: Non-recovery AKI is associated with an increased risk of hypoglycemia, regardless of whether de novo CKD develops, and is linked to lower mean A1c level within two-years post-discharge. Identifying high-risk individuals for post-AKI hypoglycemia is vital for optimal patient care.