title: Accelerated decline of renal function in type 2 diabetes following severe hypoglycemia.
abstract: OBJECTIVE
  This study aimed to evaluate whether the pronounced elevation in blood pressure during severe hypoglycemia is associated with subsequent renal insufficiency.
  
  
  METHODS
  We conducted a 3-year cohort study to assess the clinical course of renal function in type 2 diabetes patients with or without blood pressure surge during severe hypoglycemia.
  
  
  RESULTS
  Of 111 type 2 diabetes patients with severe hypoglycemia, 76 exhibited an extremely high systolic blood pressure before treatment, whereas 35 demonstrated no such increase (179.1 ± 27.7 mmHg vs. 131.1 ± 20.2 mmHg, P<0.001). At 12h after treatment, systolic blood pressure did not differ significantly (131.5 ± 30.7 mmHg vs. 123.5 ± 20.7 mmHg; P=0.39). The estimated glomerular filtration rate (GFR) before and at the time of severe hypoglycemia did not significantly differ between both groups. A multivariate Cox proportional hazards regression analysis revealed that blood pressure surge during severe hypoglycemia was independently associated with a composite outcome of a more than 15 mL/min/1.73 m(2) decrease in the estimated GFR and initiation of chronic dialysis (hazard ratio, 2.68; 95% confidence interval, 1.12-6.38; P=0.02).
  
  
  CONCLUSIONS
  Renal function after severe hypoglycemia was significantly worse in type 2 diabetes patients with blood pressure surge during severe hypoglycemia than those without blood pressure surge.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke, Japan. Electronic address: ttsujimoto@hosp.ncgm.go.jp.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsujimoto
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamamoto-Honda
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Miyako
authors.initials: M
authors.lastname: Kishimoto
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noto
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Remi
authors.initials: R
authors.lastname: Hachiya
authors.affiliation: Department of Emergency Medicine and Critical Care, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.affiliation: Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke, Japan; First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kakei
authors.affiliation: Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000517:prevention & control; D007003:Hypoglycemia / Q000503:physiopathology* / Q000517:prevention & control; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000209:etiology / Q000503:physiopathology*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D003404:Creatinine
keywords: Blood pressure surge; Microvascular disease; Severe hypertension; Severe hypoglycemia; Type 2 diabetes