Association of hyperglycemic crisis with an increased risk of end-stage renal disease: A nationwide population-based cohort study

A hyperglycemic crisis episode (HCE) is associated with poor management of diabetes, which is a risk factor for end-stage renal disease (ESRD); however, the association between an HCE and ESRD has not been clarified. We conducted a nationwide population-based cohort study with the purpose of delineating this issue. We identified 9208 diabetic patients with an HCE and an identical number of diabetic patients with matched age, sex, and index date without an HCE between 2000 and 2002. A comparison of the risk of ESRD between the diabetic patients with and without an HCE was achieved by a follow-up until 2014. A Cox proportional hazard regression analysis showed that the diabetic patients with an HCE were at a higher risk of ESRD than those without an HCE (the adjusted hazard ratio [AHR]: 1.47; 95% confidence interval [CI]: 1.34–1.62) by adjusting for renal disease, hypertension, hyperlipidemia, coronary artery disease, hyperuricemia, anemia, chronic obstructive pulmonary disease, liver disease, malignancy, connective tissue disease, non-steroid anti-inflammatory drug use, and monthly income. The increased risk of ESRD was more prominent in the age subgroup of 15–25 years (AHR: 4.91; 95% CI: 1.92–12.56); 25–35 years (AHR: 2.42; 95% CI: 1.51–3.86); 35–45 years (AHR: 3.01; 95% CI: 2.21–4.09); and 45–55 years (AHR: 1.75; 95% CI: 1.41–2.19). An HCE was associated with an increased risk of ESRD, especially in the younger diabetic patients (15–55 years). A close follow-up for the control of diabetes and for monitoring renal function is proposed.