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Objective: To identify the incidence of and risk factors for hypoglycemia in patients with chronic kidney disease (CKD) stage III-V or end stage renal disease (ESRD) treated with intravenous (IV) insulin for hyperkalemia. Design: Single-center, retrospective, cohort study. Setting: Large academic tertiary care medical center. Patients: Adults with a diagnosis of CKD stage III-V or ESRD who had a serum potassium ≥ 5 mmol/L and were treated with regular insulin for hyperkalemia between October 1, 2015 and August 16, 2016. Measurements and main results: The primary outcome was the incidence of hypoglycemia during the hospitalization after the administration of insulin for hyperkalemia. Key secondary outcomes included incidence of hypoglycemia within 24 hours of insulin administration and identification of risk factors associated with hypoglycemia. Data collected included patient age, sex, race, history of diabetes, stage of CKD, weight, body mass index (BMI), baseline blood glucose, inciting serum potassium concentration, units of regular insulin administered, and grams of dextrose given with insulin. A total of 235 hospitalizations were included in the final analysis. Sixty-six patients (28.1%) experienced a hypoglycemic event during their hospital encounter. Fifty-three patients (22.6%) had hypoglycemia within 24 hours of insulin administration. The average time to onset of hypoglycemia was 21.2 hours in all patients who experienced hypoglycemia and 6.4 hours in the subset of patients who experienced hypoglycemia within 24 hours of insulin administration. Inciting potassium was significantly higher and baseline blood glucose was significantly lower in the group that experienced hypoglycemia (P = 0.01, P = 0.02, respectively). Conclusion: Hypoglycemia following treatment for hyperkalemia with IV regular insulin was common in this patient population. Consideration should be given to the development of a comprehensive order set for insulin use in hyperkalemia to include protocol driven glucose monitoring with dextrose administration tailored to baseline glucose levels.

international archives of clinical pharmacology

Incidence of Hypoglycemia in Patients with Renal Dysfunction Treated for Hyperkalemia with Regular Insulin: A Single Center, Retrospective Cohort Study