title: Increased risk of stroke in patients with chronic kidney disease after recurrent hypoglycemia.
abstract: OBJECTIVE
  In this study, we aimed to investigate the effect of hypoglycemia on cardiovascular outcomes in a sample of patients with chronic kidney disease (CKD).
  
  
  METHODS
  Information about study participants was extracted from the National Health Insurance Research Database of Taiwan for the years 1998 through 2008. We conducted this retrospective cohort study of patients with CKD, with and without hypoglycemia, to evaluate the risk of overall mortality and cardiovascular complications including stroke, coronary heart disease, and congestive heart failure in both groups.
  
  
  RESULTS
  This study included 46,135 patients with CKD, of whom 2,117 (4.59%) were hospitalized and had hypoglycemia. Results of multivariate Cox proportional hazard regression analyses indicated that stroke (hazard ratio [HR] = 1.62, 95% confidence interval [CI] = 1.29-2.03), coronary heart disease (HR = 1.25, 95% CI = 1.00-1.57), congestive heart failure (HR = 1.49, 95% CI = 1.13-1.98), and death (HR = 2.53, 95% CI = 1.99-3.21) were associated with hypoglycemia in patients with CKD. Recurrent episodes of hypoglycemia were associated with a higher risk of death (HR = 33.0, 95% CI = 22.3-48.8 for >2 episodes, p for trend <0.0001), and a similar trend was observed for other multiple cardiovascular events. We observed an increased risk of stroke and overall mortality in patients with hypoglycemia compared to those without hypoglycemia, regardless of whether the patient had diabetes.
  
  
  CONCLUSIONS
  CKD was associated with a higher risk of stroke and mortality in patients with hypoglycemia. Recurrent hypoglycemia considerably increased the risk of stroke and overall mortality in patients with CKD regardless of whether they had diabetes. These results suggest that hypoglycemia has a crucial role in stroke and death in patients with CKD.
authors.affiliation: From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan.
authors.forename: Tung-Min
authors.initials: TM
authors.lastname: Yu
authors.affiliation: From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Ni
authors.initials: SN
authors.lastname: Chang
authors.affiliation: From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan. d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D008297:Male; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D013624:Taiwan