OBJECTIVES: Diabetic patients with chronic renal failure are at risk of developing hypoglycemia and metabolic acidosis. The purpose of this study was to estimate the health care resource utilization and costs associated with these complications. METHODS: Patients covered by the Quebec provincial drug reimbursement program (RAMQ) who had a diagnosis of diabetes, had used a hypoglycemic agent, and who had experienced hypoglycemia or metabolic acidosis in the period from January 2005 to December 2010 were selected. Health care resources in terms of physician visits, hospitalization, intensive care unit stay, hospital outpatient clinic visits, and emergency room visits were estimated for the 10-day period before and the 30-day period after a complication event. The resources consumed during a 40-day period one year before the event, corresponding to a period without any complication event, was deducted to estimate the incremental costs associated with these complications. RESULTS: A total of 4889 patients had a diagnosis of diabetes with chronic renal failure (average age 69.2 years (SD=10.1)). Of these, 530 (10.8%) experienced a hypoglycemic event and 95 (1.9%) an episode of metabolic acidosis. Estimated incremental costs of medical resources were $3859 for hypoglycemia and $5019 for metabolic acidosis. In both cases, hospitalization was the major cost coponent: $2560 and $3065 for hypoglycemia and metabolic acidosis, respectively. CONCLUSIONS: A significant proportion of diabetic patients with chronic renal failure experienced hypoglycemia or metabolic acidosis, with substantial associated costs. Treatment options that minimize the risk of these complications should be considered.