The Impact of Hyperglycemic Emergencies on the Kidney and Liver

Abstract

Studies on the alterations of liver and kidney function parameters in patients with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) were limited. Participants with DKA, DK, non-DK, and healthy controls were enrolled in the current study. Parameters of liver and kidney function were measured and evaluated. The patients with DKA had higher levels of plasma glucose, hemoglobin A1c (HbA1c), uric acid, and creatinine but lower levels of transferases and protein compared with the other three groups (P < 0.05 for all). The patients with DK had higher levels of plasma glucose and HbA1c but lower levels of glutamyl transpeptidase and protein compared with the non-DK and control groups (P < 0.05). Prealbumin levels were significantly reduced in the severe DKA patients compared with the mild/moderate DKA patients. Serum prealbumin levels were correlated with albumin levels (r = 0.401, P = 0.010), HCO3 (r = 0.350, P = 0.027), and arterial pH (r = 0.597, P < 0.001) in the DKA patients. A diagnostic analysis showed that lower prealbumin levels significantly reflected the presence of hyperglycemic emergencies (P < 0.001). Liver and kidney function parameters deteriorated, especially in DKA. Prealbumin levels can be of value in detecting the presence of hyperglycemic crisis. This clinical trial is registered with ChiCTR-OCH-12003077.

Surrogate Markers of the Kidney and Liver in the Assessment of Gestational Diabetes Mellitus and Fetal Outcome

“…Based on the present results and previous studies [5,6,9], it is suggested that hyperglycemia was the important cause of higher levels of BChE, γ-GT, Cys-C, and pre-albumin in women with GDM. Lowering blood glucose can reduce insulin resistance and oxidative stress and improve endothelial function in GDM [11].…”

“…Insulin therapy is the cornerstone of treatment for GDM, which can also result in an anti-inflammatory effect [11]. Our previous study demonstrated that insulin administration had a favorable effect on glucose levels, oxidative stress, and inflammatory cytokines [9,12]. Although the exact mechanism behind this phenomenon is unclear, this study showed that the most significant factor influencing γ-GT and pre-albumin levels should be diabetes status.…”

“…Our previous study showed that liver and kidney function parameters deteriorated, especially in diabetic ketoacidosis. Lower prealbumin levels significantly reflected the presence of hyperglycemic emergencies [9]. To our knowledge, there is no available study on the patterns or prognostic value of pre-albumin levels in patients with GDM.…”

“…Laboratory tests including ALT, AST, BChE, Cys-C, γ-GT, and prealbumin were performed using routine laboratory methods [6,9]. Blood samples were collected into tubes for tests and immediately processed using an Olympus AU 2700 autoanalyser (Olympus, Tokyo, Japan).…”

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

“…Diabetic patients, both type 1 and type 2, show an elevation in their liver enzymes that in most cases associated with non-alcoholic fatty liver disease (NAFLD) [60, 61]. Liver parameters were found to be deteriorated in diabetic patients with elevated blood ketones [62]. Additionally, ketosis onset diabetic group had higher incidence of NAFLD than that of non-ketotic onset diabetic group [63], suggesting that hyperketonemia could be a possible risk factor in the onset of fatty liver and obesity.…”