Clinical Characteristics and Outcomes in Patients Admitted with Diabetic Ketoacidosis (DKA) and End-Stage Renal Disease (ESRD)

Abstract

Management of patients with diabetic ketoacidosis (DKA) and end stage renal disease (ESRD) is challenging. We used data (ICD-9/10 codes and clinical) from the Emory Clinical Data Warehouse from 1/1/2006-12/31/2016 to determine the clinical presentation and outcomes of patients with DKA. DKA was confirmed with admission bicarbonate <18 mEq/L, beta-hydroxybutyrate >3 mmol/L, and pH < 7.3, during the first encounter. ESRD was defined as glomerular filtration rate <15 mL/min/1.73 m2. Among 681 patients admitted with DKA (45±18 years, 51% female); there were 65 (9.5%) and 616 (90.5%) patients with and without ESRD, respectively. On admission, patients with ESRD were older, more likely to be female, and had admission blood glucose, potassium and osmolality higher than patients without ESRD, Table. Patients with ESRD had longer length-of-stay (LOS); however, there were no differences in admission anion gap, pH, time-to-correction of hyperglycemia, hypoglycemia and hypokalemia rates, or hospital mortality between groups. About one in every ten patients admitted with DKA has ESRD. Patients with DKA and ESRD were older, presented with more severe hyperglycemia and had longer LOS; however, response to therapy and mortality was similar to patients without ESRD.DKA with ESRD n: 65 (9.5%)DKA without ESRD n: 616 (90.5%)p-valueAge, years57.4 ± 15.243.7 ± 17.40.001Female, n (%)41 (63)3(50)0.04BMI, mean (kg/m2)29.6± 9.227.2 ± 7.50.033HbA1c, %9.9 ± 2.611.7 ± 2.80.003BG, mg/dl753.6 ± 441585 ± 2500.003Anion Gap, mEq/L22.9 ± 722.8 ± 60.95Bicarbonate, mmol/L12.0 ± 411.5 ± 3.90.26Effective Osm, mOsm/kg303.9 ± 23296.7 ± 170.02Sodium, mmol/L131.0 ± 7132.1 ± 60.12Beta-hydroxybutyrate, mmol/L5.0 ± 3.16.3 ± 2.50.02Admission potassium, mEq/L5.7 ± 1.45.1 ± 1.1<0.001Time to BG < 250 mg/dl, minutes372.1 ± 279415 ± 2260.79Hospital mortality, n (%)2 (3)11 (2)0.36LOS, median days (Q1, Q3)8 (5, 16)3 (2, 5)<0.001Hypoglycemia <70 mg/dl, n (%)10 (15)77 (13)0.56Hypokalemia < 3.0 mEq/L, n (%)16 (25)126 (20)0.43 Disclosure R.J. Galindo: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc.. K.G. Tsegka: None. S. Cardona: None. N. Dhruv: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. M. Fayfman: None. J. Haw: None. A. Migdal: None. S. Nair: None. H. Wang: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..