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.
Highlights
Children with diabetic ketoacidosis (DKA) experience varying degrees of dehydration and electrolyte imbalance due to osmotic diuresis [1, 2]
In patients with severe acute kidney injury (AKI), a negative correlation (R = 0.27, P = 0.058) with borderline significance between estimated glomerular filtration rate (eGFR) and recovery time from metabolic acidosis was found (Fig 1C). This was the largest study to date that analyzed the prevalence and clinical markers of AKI in children and adolescents admitted for DKA, and it was the first study that focused on young East Asian patients
It is worth noting that the serum creatinine level is an insensitive and delayed marker of impaired renal function [26]; the kidneys may be injured before serum creatinine levels are elevated, which may imply that the actual prevalence of AKI in children with DKA might be higher than expected
Summary
Children with diabetic ketoacidosis (DKA) experience varying degrees of dehydration and electrolyte imbalance due to osmotic diuresis [1, 2]. Persistent polyuria is the most common symptom in children with DKA and can lead to progressive dehydration [3]. The compensatory mechanism for dehydration in children has not been well established; children are more vulnerable to volume depletion than adults [4]. Prerenal acute kidney injury (AKI) may occur, and acute tubular necrosis may subsequently develop in patients with severe volume depletion [5,6,7]. AKI is an independent factor associated with longer hospital stay and higher mortality rate in children [10]
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