Predictors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Baalaaji, Mullai; Jayashree, Muralidharan; Nallasamy, Karthi; Singhi, Sunit; Bansal, Arun

doi:10.1007/s13312-018-1274-8

Cited by 42 publications

(59 citation statements)

References 14 publications

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“…Both studies demonstrated that a high proportion of patients hospitalized for DKA developed AKI, which is consistent with our findings. In contrast, the prevalence of AKI in children with DKA was only 35.4% in India [20]; however, the baseline creatinine clearance they used to define AKI was not mentioned in their study. A recent study in Israel showed that the proportion of children with AKI who were admitted for DKA was only 30% [21], which is much lower than our result.…”

Section: Discussionmentioning

confidence: 90%

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

Huang

Lin

et al. 2020

PLoS ONE

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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.

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Section: Discussionmentioning

confidence: 90%

“…The reported prevalence of AKI in patients with DKA has been highly variable across different studies [19][20][21][22]. In the study of Orban et al, which included 94 patients, 50% of adults who were admitted for DKA met the RIFLE criteria for AKI [22].…”

Section: Discussionmentioning

confidence: 99%

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

Huang

Lin

et al. 2020

PLoS ONE

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“…Another serious consequence of DKA is the development of AKI. Despite the fact that, AKI occurs at a higher rate in hyperglycemic hypoerosmolar state, it's incidence on children with DKA is scarce 18,19 . The recent report from Weissbach et al, demonstrated the AKI incidence at DKA presence as 30% possibly due to prerenal mechanisms 20 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with resolution of diabetic ketoacidosis in pediatric critical care units

Ongun¹,

Çelik²

2019

Cumhuriyet Medical Journal

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Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type-I Diabetes Mellitus. The goals of therapy are to correct dehydration, resolution of acidosis and fading of ketosis. Such serious complications necessitate closed monitoring of DKA patients with delicate, balanced therapy, probably at an intensive care facility. Regarding the fact that, each facility shoul determine the clinical profile of their own patient population, we aimed to investigate the risk factors for consequences and determine the timing of DKA resolution by analyzing the demographic and epidemiologic data, clinical outcome and the prognosis of diabetic ketoacidotic children admitted to PICU. Method: This descriptive, retrospective study was conducted in 105 children admitted to PICU with the complaints of DKA between January 2014 and December 2108. Demograhic data including age, gender, weight, height, body mass index (BMI), initial compliants with clinical findings and level of consciousness were recorded. Children were categorized into two groups depending on the timing of DM diagnosis (new onset of diabetes and established diabetes mellitus). DKA severity was determined by the degree of metabolic acidosis (mild, moderate, severe). SPSS-23 was used for statictics. Descriptive analyses were expressed as percentages, mean±standart deviation (SD), median with minimum and maximum values. Chi square and Fischer exact test were used for comparison of categorical variables. Student's t-test, Mann Whitney U test and Wilcoxon rank sum test were assessed for continous variables. Pearson correlation coefficient and logistic regressions were used for correlations and to determine the risk factors. P-value < 0.05 was considered significant. Results: The patient demographics presented the mean age as 11.31±4.18 years, female/male ratio 1/1.4 and body mass index 18.48±4.48. Children were classified as mild DKA (29.5%), moderate DKA (35.2%) and severe DKA (35.2%) based on the acidosis severity. 48.6% of the patients had Kusmaull respiration; 30.5% had manifested altered consciousness. One patient had tomography-proven brain edema and had required mechanical ventilation due to neurological incapability to sustain airway. Children with new onset of diabetes accounted for 51.4% of the study population. The mean age was 9.70±4.47 years; this group constituted a younger population compared the established DM patients (p<0.001). Altered mental state and kusmaull respiration also occurred at a higher rate and the major complaint seemed ae weight loss within two weeks (p=0.006, p=0.002, p<0.001 respectively). Children with established diabetes mellitus presented significant biochemical abnormalities in terms of elevated BUN and serum potassium levels (p<0.001, p<0.001); infections occurred as the major triggering factor for DKA at a rate of 80.4% at this group. We observed a positive correlation with DKA resolution with serum creatinine, calculated osmolality, anion gap (r=0.242, r=0.215, r=0.302) and a negative correlation with...

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“…The chloride elevation in this study was very modest in both groups-only 4 mmol/L for the Plasma-Lyte group and 6 mmol/L for the normal saline group [1]. If we look at the study of Baalaaji et al [2], where all the patients were resuscitated with saline, the chloride in the non-AKI group was 106.6 mmol/L versus 118.6 mmol/L in the AKI group, a difference in chloride of 12 mmol/L [2]. In that study, twenty-eight (35%) children were diagnosed with AKI: twenty (71.4%) recovered with hydration alone while 8 (28.6%) required RRT [2].…”

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confidence: 57%

The causal link between hyperchloremia and acute kidney injury is yet to be conclusively established: we are not sure

et al. 2020

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Predictors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Abstract: Majority of children with AKI and DKA, recover with hydration. Hyperchloremia at 24 hours had independent association with AKI, although cause-effect relation could not be ascertained.

Cited by 42 publications

References 14 publications

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

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

Risk factors associated with resolution of diabetic ketoacidosis in pediatric critical care units

The causal link between hyperchloremia and acute kidney injury is yet to be conclusively established: we are not sure

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