Factors associated with hypoglycemia in diabetic patients undergoing hemodialysis: A case-control analysis

Background: Managing diabetes in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is challenging due to impaired glycemic control. Hypoglycemia is a common concern in this population. This study assessed the prevalence and risk factors for hypoglycemia among diabetic patients on HD. Objective: To determine the incidence and identify predictors of hypoglycemia in diabetic patients undergoing HD. Methods: This prospective case-control study included 144 diabetic patients on dialysis, with 72 experiencing hypoglycemia (cases) and 72 without hypoglycemia (controls). Data were statistically analyzed to identify risk factors. Results: Among cases, 62.5% were males and 37.5% females, compared to 72.22% males and 27.77% females in controls. Cases had a lower mean albumin level (3.31 g/dl) than controls (3.54 g/dl), indicating hypoalbuminemia as a significant risk factor. The mean HbA1c level was higher in cases (7.97%) compared to controls (7.09%), suggesting poor diabetes control. Coronary artery disease (CAD) was more prevalent in cases (37.5%) than controls (25%), identifying it as a risk factor, whereas dyslipidemia (DLP) was higher in controls (25%) than cases (12.5%), suggesting a protective effect. Drug use analysis showed a strong positive correlation of Quetiapine (r=0.522) and Mirtazapine (r=0.467) with hypoglycemia. The odds of getting hypoglycemia increases by 1.56 times for each unit increase in HbA1C, 1.05 times for each unit increase in long-acting insulin. The odds of getting hypoglycemia declines approximately by 1 time for each unit reduction in total iron binding capacity (TIBC) and increasing Transferrin saturation. Conclusion: Hypoalbuminemia, uncontrolled diabetes, CAD, and certain medications increased the risk of hypoglycemia in diabetic HD patients, while DLP was protective. Careful monitoring and medication management are essential to mitigate the risk of hypoglycemia in this population.