Acute Kidney Injury in Pediatric Diabetic Ketoacidosis
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ORIGINAL ARTICLE
Acute Kidney Injury in Pediatric Diabetic Ketoacidosis Eun Mi Yang 1
&
Hyun Gyung Lee 1
&
Ka Young Oh 2
&
Chan Jong Kim 1
Received: 29 January 2020 / Accepted: 14 October 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objective To assess the incidence and clinical characteristics of acute kidney injury (AKI) and identify the associated risk factors for AKI in children with type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). Methods This was a retrospective study performed over 15 y in a single Korean center. Children aged ≤18-y-old with T1DM and DKA were enrolled and divided into 2 groups according to the presence of AKI. Results This study included 90 episodes of DKA in 58 children with T1DM. AKI occurred in a total of 70 hospitalizations (77.8%) of 44 children: 18 (20.0%) with stage 1 AKI, 39 (43.3%) with stage 2 AKI, and 13 (14.4%) with stage 3 AKI. The number of AKI decreased to 28 (47.4%) and 13 (28.3%) after 12 h and 24 h of admission, respectively. The white blood cell count (P = 0.001) and anion gap levels (P = 0.025) were significantly higher and serum bicarbonate level (P = 0.004) was lower in the AKI group. Logistic regression analysis revealed that a longer duration of TIDM and high anion gap were independent predictors of developing severe AKI in pediatric DKA with T1DM (odds ratio, 1.225, P = 0.013; odds ratio, 1.130, P = 0.038). Conclusions AKI frequently occurred in TIDM children with DKA. Longer duration of TIDM and elevated anion gap are associated with occurrence of severe AKI. Keywords Diabetic ketoacidosis . Acute kidney injury . Diabetes mellitus . Children
Introduction Type 1 diabetes mellitus (T1DM) is a common, chronic, metabolic disorder that has significant consequences for physical and emotional development [1]. The incidence of TIDM is steadily increasing in nearly all parts of the world by about 2–5% per year [1–3]. Diabetic ketoacidosis (DKA) is the most serious complication of TIDM and results from metabolic abnormalities due to a severe deficiency of insulin or insulin effectiveness. Similar to diabetes, DKA has an increasing incidence [2] and more frequently occurs in children [4]. DKA occurs in 20–40% of children with new-onset diabetes and in children with known diabetes who omit insulin doses or who do not successfully manage during intercurrent illness [1]. Although the inpatient mortality rates of DKA are generally very low [5, 6], DKA is the leading
* Chan Jong Kim [email protected] 1
Department of Pediatrics, Chonnam National University Hospital and Medical School, Gwangju, South Korea
2
Department of Pediatrics, Jeil Hospital, Yeosu, South Korea
cause of hospitalization, morbidity, and mortality in children with TIDM [7]. DKA is associated with numerous acid-base, hydration and electrolyte derangements. Accompanied by both volume depletion and subsequent massive fluid-rehydration treatment upon presentation, children with DKA potentially have a high risk for acute kidney injury (AKI). For decades, nonconsensual definitions of AKI
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