Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease

Abstract

Introduction: Fluid overload is a known complication in patients with diabetes mellitus, particularly those with cardiovascular and/or chronic kidney disease (CKD). This study investigates the impact of fluid overload on healthcare utilisation and its association with diabetes-related complications. Method: Electronic medical records from the SingHealth Diabetes Registry (2013–2022) were analysed. Hospitalisations due to fluid overload were identified using International Classification of Diseases, 10th Revision (ICD-10) discharge codes. Trends were examined using Joinpoint regression, and associations were assessed with generalised estimating equation models. Results: Over a period of 10 years, 259,607 individuals treated at primary care clinics and tertiary hospitals were studied. The incidence of fluid overload-related hospitalisations decreased from 2.99% (n=2778) in 2013 to 2.18% (n=2617) in 2017. However, this incidence increased from 2.42% (n=3091) in 2018 to 3.71% (n=5103) in 2022. The strongest associations for fluid overload-related hospitalisation were found with CKD stages G5 (odds ratio [OR] 6.61, 95% confidence interval [CI] 6.26–6.99), G4 (OR 5.55, 95% CI 5.26–5.86) and G3b (OR 3.18, 95% CI 3.02–3.35), as well as with ischaemic heart disease (OR 3.97, 95% CI 3.84–4.11), acute myocardial infarction (OR 3.07, 95% CI 2.97–3.18) and hypertension (OR 3.90, 95% CI 3.45–4.41). Additionally, the prevalence of stage G5 CKD among patients with fluid overload increased between 2018 and 2022. Conclusion: Our study revealed a significant increase in fluid overload-related hospitalisations and extended lengths of stay, likely driven by severe CKD. This underscores an urgent need for initiatives aimed at slowing CKD progression and reducing fluid overload-related hospitalisations in diabetes patients.