Does kidney function influence hypoglycemia risk?

This study looked at the relationship between kidney function and hypoglycemia in patients with diabetes. It found that patients with low kidney function had hypoglycemia more frequently, and the episodes were more severe.

Diabetes is a disorder leading to high levels of glucose (sugar) in the blood. High levels of glucose can damage the kidneys. Patients with diabetes have a higher risk of kidney disease, and roughly 45% of patients with advanced kidney disease also have diabetes. 

The kidneys are responsible for filtering the blood, removing waste into the urine while keeping nutrients including sugar, salt, and proteins in the blood. The kidneys help maintain adequate levels of blood glucose. The kidneys can also create more glucose when blood sugar levels are low.

Hypoglycemia occurs when blood glucose levels drop abnormally low. Untreated hypoglycemia can be dangerous, with a risk of seizures and death. Patients with diabetes can experience episodes of hypoglycemia if their insulin or other medications remove more glucose than they are consuming. It is unclear whether patients with diabetes and kidney damage have a higher risk of hypoglycemia.

This study included records from 29,434 adult patients with diabetes. Patients’ kidney function was measured using estimated glomerular filtration rate (eGFR). The lower the eGFR, the lower the kidney function. Hypoglycemia episodes were recorded.

20% of patients had chronic kidney disease (eGFR less than 60 mL/min/1.73 m²). Patients with lower kidney function had more complications and simultaneous medical conditions, such as heart disease. 

There were 2,397 recorded episodes of hypoglycemia. 1,812 patients (6.2%) had at least one episode. Patients with moderate chronic kidney disease (eGFR between 45 and 59 mL/min/1.73 m²) had hypoglycemia 50% more frequently than those with normal kidney function. Patients with kidney failure (eGFR below 15 mL/min/1.73 m²) experienced hypoglycemia 5.8 times as frequently as patients with normal kidney function. The risk of dying due to hypoglycemia also increased with worse kidney function.

This large study found that patients with diabetes and low kidney function experienced hypoglycemia more frequently. The authors suggest that kidney function should be monitored in patients with diabetes.

This study used patient records. It could not show that low kidney function caused hypoglycemia, only that they are connected.

Talk to your doctor about your kidney function and how it relates to your diabetes.