Clinical Outcomes and Mortality among Patients Hospitalized with Hypoglycemia and End-Stage Renal Disease in the U.S.

Patients with diabetes and end stage renal disease (ESRD) are at high risk of hypoglycemia. The prevalence and outcomes among hospitalized patients with hypoglycemia and ESRD in the U.S. is not known. Accordingly, we compared the outcomes of patients hospitalized for hypoglycemia with and without ESRD in a U.S. nationwide cohort. We searched the National Inpatient Sample (largest public inpatient database in the U.S.), for adult patients (>18 years) in 2014. We used ICD9 codes to identify admissions for hypoglycemia (primary diagnosis) and ESRD (secondary diagnosis), defined as stage 5 chronic kidney disease, with or without dialysis. Among 97,445 patients admitted for hypoglycemia, 11,285 (11.6%) had ESRD. Patients with ESRD were more likely of African-American and Hispanic race, and had a higher mortality rate, longer length-of-stay (LOS) and higher hospitalization costs compared to those without ESRD (Table). In multivariate analysis, ESRD was significantly associated with an increased odds for mortality (OR 2.92, 95% CI 1.98, 4.29, p<0.01), longer LOS (p<0.001) and higher hospitalization costs (p<0.001). Among patients with hypoglycemia, ESRD is common (11.5%) and is associated with a 3-fold increase in mortality, longer LOS and higher hospitalization costs. Further research on treatment strategies to decrease the burden of hypoglycemia in this population is needed.