Children With Diabetic Ketoacidosis at High Risk of AKI

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A 22% increase in odds of developing AKI was seen for each initial heart rate increase of 5 beats per minute.
A 22% increase in odds of developing AKI was seen for each initial heart rate increase of 5 beats per minute.

Among children with type 1 diabetes, new data published in JAMA Pediatrics demonstrate that a high proportion of those who are hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI).

The researchers of the study aimed to establish the proportion of children hospitalized for DKA who develop AKI, and to ascertain the clinical and biochemical markers associated with AKI.

Overall, the medial record review included all DKA admissions from September 1, 2008, through December 31, 2013, that were conducted at the British Columbia Children's Hospital in British Columbia, Canada. The researchers included 165 children (age, ≤18 years; median age, 10.6 years; 53.9% female) with type 1 diabetes and DKA and with complete medical records available for analysis.

 

The primary outcome was AKI, defined via the Kidney Disease/Improving Global Outcomes serum creatinine criteria. The researchers used multinomial logistic regression to determine potential factors associated with AKI.

Results indicated that 64.2% of children developed AKI, of whom 34.9% had stage 1, 45.3% had stage 2, and 19.8% had stage 3, and 2 children required hemodialysis.

According to the adjusted multinomial logistic regression model, a serum bicarbonate level <10 mEq/L compared with ≥10 mEq/L yielded a more than 5-fold increase in the likelihood of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22).

For each initial heart rate increase of 5 beats per minute, the researchers observed a 22% increase in the odds for severe AKI (aOR, 1.22; 95% CI, 1.07-1.39).

In addition, compared with an initial corrected sodium level of 135-144 mEq/L, those with a level of ≥145 mEq/L had a more than 3-fold increase in the odds of mild (stage 1) AKI (aOR, 3.29; 95% CI, 1.25-8.66).

No instances of death in patients with or without AKI were reported.

"This study is the first to date to document that a high proportion of children hospitalized for DKA develop AKI," the researchers wrote. "[AKI] was associated with markers of volume depletion and severe acidosis."

The researchers added that AKI is concerning because it is linked to increased morbidity and mortality, as well as increased risk for chronic renal disease, a finding particularly relevant for children who are already at risk for diabetic nephropathy. "Strategies are needed to improve the diagnosis, management, and follow-up of AKI in children with type 1 diabetes," they wrote.

Reference

Hursh BE, Ronsley R, Islam N, Mammen C, Panagiotopoulos C. Acute kidney injury in children with type 1 diabetes hospitalized for diabetic ketoacidosis [published online March 13, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.0020


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