Recurrent Hypoglycemia Raises Stroke Risk in Kidney Disease Patients Interview with:
Prof. Chia-Huang Kao
From the Graduate Institute of Clinical Medical Science
Department of Radiation Oncology and Nuclear Medicine and PET Center
Graduate Institute of Clinical Medical Science
China Medical University Hospital, Taichung, Taiwan.

Medical Research: What are the main findings of the study?

Prof. Kao: Patients with chronic kidney disease (CKD) are at high risk for hypoglycemia; several factors are reported to contribute to hypoglycemia in these patients. However, most previous studies were limited by the relatively small number of patients with CKD included in the study by the exclusion of cases with CKD. In the present study, the incidence rate of hypoglycemia in patients with CKD was 4.5%, which is approximately twice the value noted in previous reports and multivariate analysis revealed a 2.53-fold increase in the risk of death for CKD patients with hypoglycemia after adjusting for related confounding factors including hypertension, hyperlipidemia, diabetes, and antidiabetic drugs.

Medical Research: Were any of the findings unexpected?

Prof. Kao: We observed a clear relationship between stroke and hypoglycemia regardless of whether the patients had diabetes. Furthermore, we observed a high risk of stroke (adjusted HR = 2.45) in the hypoglycemia patients who did not have diabetes; to date, these patients have been generally considered as a relatively low-risk group for cardiovascular events. In addition, recurrent hypoglycemia was largely associated with a significantly higher risk of stroke (adjusted HR = 11.6) in CKD patients compared to the patients without hypoglycemia.

Medical Research: What should clinicians and patients take away from your report?

Prof. Kao: Recurrent hypoglycemia is largely associated with stroke in patients with CKD, such hypoglycemia may cause a deleterious increase in sympathetic activity and the association between recurrent hypoglycemia and the risk of stroke determined in the current study may reflect a bidirectional effect. When encountering hypoglycemia in CKD patients, physicians should maintain a high index of suspicion to prevent adverse outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Kao: It is undoubted that glucose control is an important issue in general population, particular in cases with diabetes. However, the risk of hypoglycemia is strikingly increasing in some conditions such as CKD patients. It is critical to establish adequate level of blood glucose in patients with CKD.

Increased risk of stroke in patients with chronic kidney disease after recurrent hypoglycemia
Yu TM1, Lin CL1, Chang SN1, Sung FC1, Kao CH2.

Neurology. 2014 Aug 19;83(8):686-94. doi: 10.1212/WNL.0000000000000711.
Epub 2014 Jul 16.


Last Updated on August 21, 2014 by Marie Benz MD FAAD