The influence of ketoacids on plasma creatinine assays in diabetic ketoacidosis

Kemperman, F. A. W.; Weber, Julien; Gorgels, J. P. M. C.; Zanten, Anton P. van; Krediet, R. T.; Arisz, L.

doi:10.1046/j.1365-2796.2000.00768.x

Cited by 26 publications

(13 citation statements)

References 22 publications

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“…In the setting of DKA, the elevated creatinine may be due to volume depletion caused by polyuria, a false positive result caused by the increased level of acetoacetate in the body, or diabetic nephropathy. 20 Our cohort has higher rates of short-term mortality compared with other studies 13 ; there are several possible explanations for this. First, patients in Scotland who are admitted to hospital with DKA and who require critical care admission are most likely to be managed in High Dependency Units.…”

Section: Discussionmentioning

confidence: 60%

Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study

Ramaesh

2016

Journal of the Intensive Care Society

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Aims: Diabetic ketoacidosis is a life-threatening but avoidable complication of diabetes mellitus often managed in intensive care units. The risk of emergency hospital readmission in patients surviving an intensive care unit episode of diabetic ketoacidosis is unknown. We aimed to report the cumulative incidence of emergency hospital readmission and costs in all patients surviving an intensive care unit episode of diabetic ketoacidosis in Scotland. Methods: We used a national six-year cohort of survivors of first diabetic ketoacidosis admissions to Scottish intensive care units (1 January 2005-31 December 2010) identified in the Scottish Intensive Care Society Audit Group registry linked to acute hospital and death records (follow-up censored 31 December 2010). Diabetic ketoacidosis-related emergency readmissions were identified using International Classification of Disease-10 codes. Results: During the study period, 386 patients were admitted to intensive care units in Scotland with diabetic ketoacidosis (admission rate 1.5/100,000 Scottish population). Median age was 44 (IQR 29-56); 51% male; 55% required no organ support on admission. Mortality after intensive care unit admission was 8% at 30 days, 18% at one year, and 35% at five years. A total of 349 patients survived their first intensive care unit diabetic ketoacidosis admission [mean (SD) age 42.5 (18.1) years; 50.4% women; 46.1% required 51 organ support]. Following hospital discharge, cumulative incidence of 90-day, one-year, and five-year diabetic ketoacidosis readmission (all-cause readmission) was 13.8% (31.8%), 29.7% (58.9%) and 46.4% (82.6%). Discussion: Diabetic ketoacidosis in patients requiring intensive care unit admission is associated with high risk of longterm mortality and high hospital costs. An understanding of the precipitating causes of diabetic ketoacidosis in patients admitted to intensive care units may allow patients who are at high risk to be targeted, potentially reducing future morbidity and the substantial burden that diabetic ketoacidosis currently places on the healthcare system.

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Section: Discussionmentioning

confidence: 60%

Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study

Ramaesh

2016

Journal of the Intensive Care Society

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“…Additionally, the creatinine level that we used to calculate eGFR via the Schwartz formula was measured using the Jaffe method. In children with metabolic ketoacidosis, the presence of acetoacetate may have resulted in falsely elevated serum creatinine levels if measured using the Jaffe method [38]. However, the Jaffe method is the most widely used approach to measure serum creatinine in our country and the only assay available that measures serum creatinine level at our institution.…”

Section: Strengths and Limitationsmentioning

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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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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“…In this study creatinine assessments were carried out with the enzymatic method. Kemperman showed that the enzymatic plasma creatinine assay is superior to estimations obtained with alkaline picrate analysis [27]. The accuracy of the formulae in this study could be influenced by the way of measuring creatinine in blood.…”

Section: Discussionmentioning

confidence: 71%

The reliability of different formulae to predict creatinine clearance

Verhave¹,

Baljé-Volkers²,

Hillege

et al. 2003

Journal of Internal Medicine

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The influence of ketoacids on plasma creatinine assays in diabetic ketoacidosis

Abstract: Acetoacetate caused severe interference of the alkaline picrate (Jaffé) assay, which might influence therapeutic decisions at the start of diabetic ketoacidosis. Enzymatic assays lack this interference.

Cited by 26 publications

References 22 publications

Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study

Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study

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

The reliability of different formulae to predict creatinine clearance

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