title: Lower blood glucose and variability are associated with earlier recovery from renal injury caused by episodic urinary tract infection in advanced type 2 diabetic chronic kidney disease.
abstract: OBJECTIVE
  In our previous study, type 2 diabetic chronic kidney disease (CKD) patients with glomerular filtration rates of <30 mL/min upon hospitalization for urinary tract infection (UTI) were at a risk for acute kidney injury. This study aimed to clarify the effect of glucose and its variability on renal outcomes during admission for the treatment of UTI.
  
  
  METHODS
  Based on the date of renal recovery (RIFLE criteria: acute kidney injury occurred within 1-7 days and was sustained over 1 day), we divided these patients into early- (≤9 days, Group A) and late-recovery (>9 days, Group B) groups. The differences in the continuous and categorical variables of the two groups were assessed separately. The mean glucose levels and their variability (using the standard deviation and the coefficient of standard deviation) were compared at the fasting, midday pre-meal, evening pre-meal, and evening post-meal time points during hospitalization. We have organized the manuscript in a manner compliant with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement.
  
  
  RESULTS
  Acute kidney injury occurred within the two groups (p = 0.007 and p = 0.001, respectively). The early-morning blood glucose levels (149.7±44.0 mg/dL) and average blood glucose levels (185.6±52.0 mg/dL) were better in Group A (p = 0.01, p = 0.02). Group A patients also had lower glucose variability than Group B at the different time points (p<0.05). Group A also had earlier renal recovery. More relevant pathogens were identified from blood in Group B (p = 0.038).
  
  
  CONCLUSIONS
  Early-morning fasting and mean blood glucose levels and their variability can be good indicators of severe infection and predictors of renal outcome in type 2 diabetic patients with CKD and UTI.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.affiliation: Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Huang
authors.affiliation: Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hung-Hsiang
authors.initials: HH
authors.lastname: Liou
authors.affiliation: Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chirn-Bin
authors.initials: CB
authors.lastname: Chang
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chia-Chu
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose