Stress Hyperglycemia and Long-term Outcomes in Patients with AKI Requiring Continuous Kidney Replacement Therapy

Background: Stress hyperglycemia is hyperglycemia that occurs during various stressful situations in patients without diabetes and is associated with poor outcomes in critically ill patients. We investigated the impact of stress hyperglycemia on outcomes during hospitalization in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: This retrospective cohort study using the Korean Health Insurance Review and Assessment database included 11,013 adult patients with AKI who received CRRT for ≥ 3 days between 2010 and 2019 and survived until discharge. Patients with pre-existing diabetes were excluded to evaluate stress hyperglycemia. Patients were divided into the two groups: hyperglycemia group and control group. Hyperglycemia was defined as the prescription of oral hypoglycemic agents or insulin treatment ≥ 7 days during hospitalization. Cox proportional model was used to estimate the risk of cardiovascular events, all-cause mortality, new-onset diabetes. Results: Among the patients who survived and discharged, 2,409 (21.9%) patients have hyperglycemia during hospitalization. While overall incidence of major cardiovascular events was comparable between the groups, the hyperglycemia group had a higher risk of incident acute myocardial infarction (HR = 1.53, 95% CI = 1.11–2.12) and revascularization (HR = 1.41, 95% CI = 1.02–1.94) compared to the control group. There was no difference in mortality between the two groups (HR = 0.92, 95% CI = 0.86–0.99). Among the patients who were alive for ≥ 1 year after discharge (N = 5,944), the hyperglycemia group had a higher risk of new-onset diabetes (HR = 10.10, 95% CI = 6.92–14.73). Conclusion: In critically ill patients with AKI requiring CRRT, stress hyperglycemia during hospitalization is associated with an increased risk of coronary events and new-onset diabetes after discharge, suggesting aggressive screening and treatment in these patients.