Acute kidney injury in hospitalised patients with type 2 diabetes: Associations with continuous glucose monitoring-based glucose levels, mortality, and ICU admission.

AIMS: Acute kidney injury (AKI) may increase the risk of hypoglycaemia in patients with diabetes due to reduced insulin clearance and altered glucose metabolism. However, the impact of AKI on glycaemic status in non-critically ill hospitalised patients with diabetes is not well understood.

METHODS

We included 166 hospitalised patients with type 2 diabetes on basal-bolus insulin monitored by continuous glucose monitoring (CGM). Kidney function was measured daily via plasma creatinine levels, and AKI was staged per Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Multivariate models assessed associations between kidney function and CGM-based glycaemic outcomes.

RESULTS

AKI correlated with a 7.3%-point (95% CI 0.3-14.2) reduction in time in range (TIR, 3.9-10.0 mmol/L), driven by increased time above range (TAR, >10.0 mmol/L), with no significant change in time below range (TBR, <3.9 mmol/L). AKI was also associated with approximately a tenfold increase in the risk of in-hospital mortality and intensive care unit (ICU) admission, and the risk of being readmitted within 30 days was twice as high. TIR decreased by 7.6%-point (95% CI 2.6-12.5) for each 100 μmol/L increase in plasma creatinine levels.

CONCLUSION

AKI and high plasma creatinine are associated with hyperglycemia, in-hospital mortality, referral to ICU, and 30-day unscheduled readmissions in hospitalised patients with type 2 diabetes. These findings challenge the prevailing focus on hypoglycemia prevention during AKI, emphasising the importance of addressing hyperglycemia as well.