High Rate of AKI in Children with Diabetic Ketoacidosis

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Nearly two-thirds of children with type 1 diabetes hospitalized for diabetic ketoacidosis (DKA) will develop acute kidney injury (AKI), suggests a study in JAMA Pediatrics.

The researchers reviewed all DKA admissions at a Canadian children’s hospital from 2008 to 2013. Complete medical records were available for 165 patients. The median age was 10.6 years; 54% were female. Three-fourths of patients were newly diagnosed with type 1 diabetes. Fifty-five percent were transferred from another hospital and nearly one-fourth were admitted to the ICU. Median initial pH was 7.1 and serum bicarbonate level 7.0 mEq/L.

Based on Kidney Disease/Improving Global Outcomes criteria, 64.2% of patients developed AKI while in the hospital. Of affected children, 34.9% had AKI stage 1, 45.3% had AKI stage 2, and 19.8% had AKI stage 3. Two patients required hemodialysis.

On adjusted analysis, factors associated with the development of stage 2 or 3 AKI were serum bicarbonate less than 10 mEq/L, adjusted odds ratio (OR) 5.22; and higher initial heart rate, OR 1.22 per increase of 5 beats/min. Odds of stage 1 AKI were increased for children with an initial corrected sodium level of 145 mEq/L or greater, OR 3.29. There were no deaths in children with or without AKI.

The study documents a high prevalence of AKI among children with DKA admitted to a tertiary care children’s hospital. This risk appears higher in children with laboratory evidence of volume depletion and severe acidosis. The authors call for prospective studies to clarify the risk factors and long-term implications of AKI in pediatric DKA—a group of young patients who already have a high long-term risk of diabetic nephropathy [Hursh BE, et al. Acute kidney injury in children with type 1 diabetes hospitalized for diabetic ketoacidosis. JAMA Pediatrics 2017; doi:10.1001/jamapediatrics.2017.0020].