Incidence, predictors, and short-term outcomes of acute kidney injury in children with diabetic ketoacidosis: a systematic review

Meena, Jitendra; Yadav, Jaivinder; Kumar, Jogender; Sharawat, Indar Kumar; Tiewosh, Karalanglin; Mittal, Aliza; Kumar, Rakesh; Dayal, Devi

doi:10.1007/s00467-023-05878-1

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…Similar to our setting, a study by Baalaaji et al [1] involving 74 pediatric DKA patients that AKI was seen in 28 (37.8%) using p-RIFLE criteria. Most studies, including a systematic review involving 4087 pediatric T1DM with 4500 DKA episodes and a recent study involving 213 pediatric DKA patients, found that any stage of AKI was 47% (95%CI 40% − 55%) and 80.75% by using KDIGO criteria respectively [2,3]. In our study, AKI by p-RIFLE was 83.8%, and KDIGO was 74%.…”

Section: Resultssupporting

confidence: 42%

“…Further, an episode of AKI during DKA was associated with a high risk for diabetic kidney disease (DKD) [4]. Studies in pediatric DKA used different de nitions (pediatric-Risk, Injury, Failure, Loss -p-RIFLE, and Kidney Disease Improving Global Outcomes -KDIGO) for AKI diagnosis and staging, but no studies compared both de nitions in pediatric DKA [1][2][3][4]. However, these de nitions have demonstrated excellent interstage discrimination in pediatric intensive care units (PICU) and non-PICU settings [5].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis (by p-RIFLE and KDIGO) and risk factors of acute kidney injury in pediatric diabetic ketoacidosis

Likhitha,

Rameshkumar,

Delhikumar

et al. 2023

Preprint

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Objective To study the extent of agreement in diagnosis (by p-RIFLE and KDIGO serum creatinine criteria) and risk factors of acute kidney injury (AKI) in pediatric diabetic ketoacidosis (DKA). Method A retrospective cohort study involving children aged ≤ 15 with DKA was conducted between January 2014 and December 2022. Inborn errors of metabolism, septic shock, and urinary tract disease were excluded. The primary outcome was the extent of agreement in diagnosis by p-RIFLE and KDIGO. The secondary outcomes were staging agreement, risk factors, complications, time to resolution of DKA, and hospital stay, including PICU. Results 161 patients' data were enrolled. Mean (SD) age was 8.6 (3.7) years. Good agreement between p-RIFLE and KDIGO criteria for diagnosis of AKI was noted at admission (Kappa = 0.71, p = < 0.001; sensitivity of 100% and specificity of 62%), at 24 hours (Kappa = 0.73, p = < 0.001; sensitivity of 100% and specificity of 72.2%) and at discharge (Kappa = 0.70, p = < 0.001; sensitivity of 100% and specificity of 77%) and also noted for the staging of AKI at admission (Kappa = 0.81, p = < 0.001), at 24 hours (Kappa = 0.73, p = < 0.001) and at discharge (Kappa = 0.70, p = < 0.001). On multivariate analysis, age (≤ 10-year: aOR = 3.28, 95%CI 1.51–7.10) and the severity of DKA (moderate: aOR = 4.18, 95%CI 1.18–14.79; severe: aOR = 4.93, 95%CI 1.29–18.80) were independent risk factors for AKI at 24-hour by KDIGO. Cerebral edema (n = 6, 3.7%), hypoglycemia (n = 66, 41%), and hypokalemia (n = 59, 36.6%) were noted. There was no difference in the resolution of DKA and hospital stay in AKI vs. no-AKI groups. Conclusion p-RIFLE and KDIGO serum criteria showed good agreement in diagnosing and staging AKI in pediatric DKA.

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Section: Resultssupporting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Diagnosis (by p-RIFLE and KDIGO) and risk factors of acute kidney injury in pediatric diabetic ketoacidosis

Likhitha,

Rameshkumar,

Delhikumar

et al. 2023

Preprint

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“…Among the commonest complications of DKA in children and adolescents is AKI, which occurs in 43% to 64% of DKA episodes in children [60,61]. In one-fourth of DKA episodes AKI is severe, suggesting severe volume depletion [62], and highlighting the need for a delicate balance between addressing the need to treat severe hypovolaemia and the potential risk of excessive fluid replacement due to the risk for cerebral injury [63]. Awareness about this complication and early recognition of AKI are important also because potassium repletion should not be started if renal function is impaired and should be withheld until output is documented [42].…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Kostopoulou¹,

Sinopidis²,

Fouzas³

et al. 2023

Preprint

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DKA represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, T2DM in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, DKA and hyperosmolar hyperglycaemic state (HHS), or between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration and restoration of shifting electrolyte disorders and underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.

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“…Diabetic ketoacidosis is often associated with severe AKI, and besides volume depletion, hyperglycemia can induce tubular injury and kidney inflammation associated with low serum bicarbonate and low sodium [19]. Moreover, one-third of non-dialyzed Shigatoxin Escherichia Coli hemolytic uremic syndrome (STEC-HUS) patients evolved to CKD after a median time of 5 years, with CKD being assessed even after 15 years, reinforcing the concept that all AKI patients should be followed until adulthood [20].…”

mentioning

confidence: 99%

Renal Biomarkers and Novel Therapies in Pediatric Nephrology: From Chronic Kidney Disease to Renal Transplantation

Chirico¹,

Mancuso²

2023

JCM

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Incidence, predictors, and short-term outcomes of acute kidney injury in children with diabetic ketoacidosis: a systematic review

Cited by 16 publications

References 33 publications

Diagnosis (by p-RIFLE and KDIGO) and risk factors of acute kidney injury in pediatric diabetic ketoacidosis

Diagnosis (by p-RIFLE and KDIGO) and risk factors of acute kidney injury in pediatric diabetic ketoacidosis

Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls

Renal Biomarkers and Novel Therapies in Pediatric Nephrology: From Chronic Kidney Disease to Renal Transplantation

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