Diabetic ketoacidosis in kids tied to acute kidney injury; claims study

Previous studies have reported that Children with diabetic ketoacidosis (DKA) experience varying degrees of dehydration and electrolyte imbalance due to osmotic diuresis . Persistent polyuria is the most common symptom in children with DKA and can lead to progressive dehydration . The compensatory mechanism for dehydration in children has not been well established; thus, children are more vulnerable to volume depletion than adults.Inspite of such reports, the prevalence and associated risk factors for AKI in children and adolescents with DKA in the East Asian population have not been reported, and the relationship between recovery time from metabolic acidosis and AKI severity in children with DKA has not been fully established.

With this in view,researchers aimed to identify the prevalence of AKI and to analyze clinical and laboratory markers associated with AKI in children and adolescents hospitalized for DKA and to determine whether an association between AKI severity and recovery time from metabolic acidosis exists during the treatment course of DKA.

For the study design, 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%]).

Data analysis revealed the following facts.

• 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.

For the full article follow the link: Huang S-K, Huang C-Y, Lin C-H, Cheng B-W, Chiang Y-T, Lee Y-C, et al. (2020) Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis. PLoS ONE 15(10): e0239160. https://doi.org/10.1371/journal.pone.0239160

Primary source: PLoS ONE