Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis

Abstract

Diabetic ketoacidosis (DKA) is associated with dehydration and which can cause acute kidney injury (AKI). The proportion of AKI in children and adolescents with DKA has not been reported in East Asian population. This study aimed to identify the prevalence of AKI and to determine whether there is an association between AKI severity and recovery time from metabolic acidosis in children and adolescents with DKA. Medical records of children and adolescents (aged <18 years) presenting with type 1 or type 2 diabetes mellitus and DKA between 2000-2017 at the MacKay Children's Hospital were retrospectively reviewed. AKI was defined by an admission creatinine level >1.5 times the calculated expected baseline creatinine level. Patients were divided into three groups based on AKI severity: no AKI, mild AKI, and severe AKI. In total, 170 (56.5%) patients with DKA presented AKI (mild AKI, 116 [38.5%]; severe AKI, 54 [18.0%]). Heart rate and laboratory parameters related to dehydration, such as corrected sodium level and blood urea nitrogen, were strongly associated with AKI development (P<0.01). Blood pH, plasma glucose, and potassium levels were also associated with AKI. A negative correlation with borderline significance between the estimated glomerular filtration rate (eGFR) and recovery time from metabolic acidosis was observed in the severe AKI group. AKI was highly prevalent in children and adolescents with DKA. An association between AKI and biomarkers indicating dehydration was noted. The recovery time from metabolic acidosis following treatment may be longer in children with a decreased eGFR who present with severe AKI. AKI is a common complication in children with DKA.

Acute Kidney Injury in Children with Diabetic Ketoacidosis: Risk Factors and Outcome

“…The DKA patients with AKI showed more than two-fold decline in glomerular filtration rate within 1 y after discharge when compared with non-AKI DKA. The recovery from metabolic acidosis following treatment may be longer in children and adolescents having severe AKI [6]. In conclusion, several risk factors lead to the development of AKI in children with DKA.…”

“…Among various etiologies of AKI, DKA is one serious condition causing mortality in these patients. The incidence of AKI in DKA reported to be ranging between 35% and 56.5% [3][4][5][6][7]. The potential risk factors for the development of AKI in these patients are volume deletion during ketoacidosis, large amount of fluid administration as 0.9% sodium chloride leading to hyperchloremia, high blood glucose, acidosis, raised uric acid, glucose-corrected sodium level, higher initial serum urea nitrogen, increased heart rate, pre-existing chronic kidney disease, and older age [4][5][6][7].…”

“…Further, higher heart rate, blood glucose and corrected sodium levels due to volume depletion complicate the course of AKI. Presence of stage 2/3 AKI may lead to longer recovery time due to reduction in glomerular filtration rate and persistent acidosis [6]. Patients of DKA with AKI require treatment with prompt correction of fluid deficit, correction of metabolic acidosis, and hyperglycemia; majority of cases may recover with these measures.…”

Acute Kidney Injury in Pediatric Diabetic Kidney Disease

“…Several mechanisms have been proposed to explain the accentuated risk of acute kidney injury (AKI) in youth with diabetes, including diabetic ketoacidosis (DKA), acute hyperglycemic events, and chronic poor glycemic control (10)(11)(12). Hyperglycemia has been shown to directly induce kidney inflammation and tubulopathy (12), while poor glycemic control can lead to polyuria with resultant volume contraction and hypovolemia, which is subsequently associated with the development of pre-renal AKI (11).…”

Tubular injury in diabetic ketoacidosis: Results from the diabetic kidney alarm study

“…More than one third of T1D youth enrolled in the SEARCH for Diabetes in Youth study had diabetic ketoacidosis (DKA) at diagnosis and in another Colorado‐based study, about 55% of youth with new diagnosis of T1D presented with DKA, 6,7 which is more frequent than what has been reported in international registries 6 . Although acute kidney injury (AKI) secondary to dehydration is a well‐recognized complication of DKA, tubular injury attributed to DKA is poorly described 5 . Pathophysiologic pathways in early DKD are thought to involve elevated serum uric acid (SUA) and vasopressin, which are also implicated in DKA 1 .…”