The incidence, risk factors, and long-term outcomes of acute kidney injury in hospitalized diabetic ketoacidosis patients

Chen, Junzhe; Zeng, Honghui; Ouyang, Xia; Zhu, Mingyao; Huang, Qiuyan; Yu, Wei; Li, Ling; Lan, Hui‐Yao; Xu, Anping; Tang, Ying

doi:10.1186/s12882-020-1709-z

Cited by 38 publications

(52 citation statements)

References 38 publications

(53 reference statements)

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“…Our study demonstrated that the incidence of AKI from DKA patients in our study is 41.3% according to 2012 KDIGO during the ICU stay. The incidence is slightly lower than is reported in previously published studies [8,9,11], but it is also higher than the general patients' comparing with DKA patients. The HLOS, hospital mortality, and use of mechanical ventilation in the AKI group were much higher than the non-AKI group, which indicated adverse effects and a considerable economic burden for patients developing AKI.…”

Section: Discussioncontrasting

confidence: 65%

“…In the multivariate regression model, T2DM patients were associated with a more than 2.5-fold increase in the odds of DKA-AKI than T1DM patients. Patients with T2DM are mostly older and with a higher percentage of being overweight; increasing age [9] and obesity [20] are associated with AKI, which could be one explanation of our result. Univariable regression analysis showed that older age is significantly associated with AKI (OR = 1.01, P < 0.05), which had no correlation weight (OR = 1.01, P = 0.06).…”

Section: Discussionmentioning

confidence: 62%

“…Glucoseinduced dehydration is the main risk factor of AKI in DKA patients [8]. Junzhe Chen et al reported 98 patients (54.75%) diagnosed as AKI among 179 DKA patients [9]. Early identification and management can decrease the AKI rate and delay its progression to the severe stage [10].…”

Section: Introductionmentioning

confidence: 99%

“…Several risk factors of developing AKI for DKA patients have been investigated over the past decade, including older age, increased glucose, serum uric acid, white blood cell count (WBC), and hyperchloremia, heart rate (HR); decreased pH, serum albumin, bicarbonate, sodium; combined with coma on admission and preexisting chronic kidney diseases (CKD) [8,9,11]. There are no currently reliable and robust predicted models available to identify high-risk patients to develop AKI based on these factors.…”

Section: Introductionmentioning

confidence: 99%

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Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database

Fan

Wang

et al. 2021

BMC Endocr Disord

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Background This study aimed to develop and validate a nomogram for predicting acute kidney injury (AKI) during the Intensive Care Unit (ICU) stay of patients with diabetic ketoacidosis (DKA). Methods A total of 760 patients diagnosed with DKA from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included and randomly divided into a training set (70%, n = 532) and a validation set (30%, n = 228). Clinical characteristics of the data set were utilized to establish a nomogram for the prediction of AKI during ICU stay. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identified candidate predictors. Meanwhile, a multivariate logistic regression analysis was performed based on variables derived from LASSO regression, in which variables with P < 0.1 were included in the final model. Then, a nomogram was constructed applying these significant risk predictors based on a multivariate logistic regression model. The discriminatory ability of the model was determined by illustrating a receiver operating curve (ROC) and calculating the area under the curve (AUC). Moreover, the calibration plot and Hosmer-Lemeshow goodness-of-fit test (HL test) were conducted to evaluate the performance of our newly bullied nomogram. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit. Results A multivariable model that included type 2 diabetes mellitus (T2DM), microangiopathy, history of congestive heart failure (CHF), history of hypertension, diastolic blood pressure (DBP), urine output, Glasgow coma scale (GCS), and respiratory rate (RR) was represented as the nomogram. The predictive model demonstrated satisfied discrimination with an AUC of 0.747 (95% CI, 0.706–0.789) in the training dataset, and 0.712 (95% CI, 0.642–0.782) in the validation set. The nomogram showed well-calibrated according to the calibration plot and HL test (P > 0.05). DCA showed that our model was clinically useful. Conclusion The nomogram predicted model for predicting AKI in patients with DKA was constructed. This predicted model can help clinical physicians to identify the patients with high risk earlier and prevent the occurrence of AKI and intervene timely to improve prognosis.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database

Fan

Wang

et al. 2021

BMC Endocr Disord

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“…Multiple risk factors contribute to the development of acute kidney injury. Acute kidney injury and advanced acute kidney injury are associated with rapid progressive chronic kidney disease and mortality in patients with diabetic ketoacidosis [ 8 ]. The development of acute kidney injury, defined as acute changes in the serum creatinine level, characterizes hospitalized patients at increased risk of adverse outcomes [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Combined Hemodialysis and Hemoperfusion with Hemoperfusion Alone in 106 Patients with Diabetic Ketoacidosis and Acute Renal Failure: A Retrospective Study from a Single Center in China

Wang

Zhang

et al. 2020

Med Sci Monit

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Background Acute kidney injury with acute renal failure is associated with severe diabetic ketoacidosis. This retrospective study was conducted at a single center in China and aimed to compare combined hemodialysis and hemoperfusion (hemodialysis+hemoperfusion) with hemoperfusion alone in 106 patients with diabetic ketoacidosis and acute renal failure. Material/Methods The 106 patients were divided into 2 groups according to different dialysis programs, with 53 cases in each group. Hemodialysis was performed using a single-pass 4008S FX8 HeLix-One hollow fiber hemodialyzer (Fresenius Medical Care, St. Wendel, Germany). Hemoperfusion was performed using HA130 resin adsorbents. Results There were no significant differences in terms of sex, age, duration of diabetes, A1c, pH, and admission blood glucose between the 2 groups ( P =0.54, 0.564, 0.53, 0.78, 0.82, 0.51). There were no significant differences in fasting blood glucose, blood urea nitrogen, osmotic pressure, and creatinine between the 2 groups before treatment ( P =0.146, 0.978, 0.786, 0.983). After treatment, blood urea nitrogen and creatinine in the dual-treatment group were lower than in the control group, and the osmotic pressure was higher than that in the control group ( P =0.000, 0.000, 0.000). The dual-treatment group experienced a lower prevalence of dizziness (5.7%), anemia (7.5%), bone pain (7.5%), hypertension (3.8%), and pruritus (5.7%) than the control group ( P <0.05). Conclusions Compared with hemoperfusion alone, hemodialysis+hemoperfusion significantly reduced pruritus and anemia, improved renal function, and was associated with significantly fewer adverse events in patients with diabetic ketoacidosis and acute renal failure.

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Association of Acute Kidney Injury During Diabetic Ketoacidosis With Risk of Microalbuminuria in Children With Type 1 Diabetes

et al. 2022

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IMPORTANCE Diabetic kidney disease is among the most important causes of end-stage kidney disease worldwide. Risk factors for diabetic kidney disease remain incompletely defined. Recent studies document a high frequency of acute kidney injury (AKI) during diabetic ketoacidosis (DKA) in children, raising the question of whether these AKI episodes might contribute to future risk of diabetic kidney disease. OBJECTIVE To determine whether episodes of AKI occurring during DKA in children are associated with increased risk of development of microalbuminuria. DESIGN, SETTING, AND PARTICIPANTS This retrospective review of medical records included children with type 1 diabetes with 1 or more urine albumin levels measured during routine diabetes care from 2 university-affiliated urban tertiary children's hospitals in the United States from January 2006 to December 2019. Age at diagnosis of diabetes, hemoglobin A 1c levels, episodes of DKA, pH and creatinine levels during DKA, and urine albumin and creatinine measurements were analyzed. Cox proportional hazards regression models were used to identify variables affecting the hazard rate for microalbuminuria development. Analyses began January 2021 and ended May 2021.EXPOSURES Episodes of DKA and episodes of AKI occurring during DKA MAIN OUTCOMES AND MEASURES AKI occurrence and AKI stage were determined from serum creatinine measurements during DKA using Kidney Disease: Improving Global Outcomes criteria. Microalbuminuria was defined as urine albumin-to-creatinine ratio of 30 mg/g or more or excretion of 30 mg or more of albumin in 24 hours. RESULTSOf 2345 children, the mean (SD) age at diagnosis was 9.4 (4.4) years. One or more episodes of DKA occurred in 963 children (41%), and AKI occurred during DKA in 560 episodes (47%). In multivariable models adjusting for the associations of age at diagnosis and mean hemoglobin A 1c level since diagnosis, each episode of AKI during DKA was associated with a hazard ratio of 1.56 (95% CI, 1.3-1.87) for development of microalbuminuria. Four or more episodes increased the hazard rate by more than 5-fold. DKA episodes without AKI did not significantly increase the hazard rate for microalbuminuria development after adjusting for other covariates.CONCLUSIONS AND RELEVANCE These data demonstrate that episodes of AKI occurring during DKA in children with type 1 diabetes are significantly associated with risk of developing microalbuminuria. Greater efforts are necessary to reduce the frequency of DKA.

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The incidence, risk factors, and long-term outcomes of acute kidney injury in hospitalized diabetic ketoacidosis patients

Cited by 38 publications

References 38 publications

Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database

Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database

Comparison of Combined Hemodialysis and Hemoperfusion with Hemoperfusion Alone in 106 Patients with Diabetic Ketoacidosis and Acute Renal Failure: A Retrospective Study from a Single Center in China

Association of Acute Kidney Injury During Diabetic Ketoacidosis With Risk of Microalbuminuria in Children With Type 1 Diabetes

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