Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is related to dehydration and can lead to acute kidney injury (AKI). No data is reporting the prevalence and associated risk factors for AKI in children and adolescents with DKA in the East Asian population. Additionally, there is less knowledge about the relationship between recovery time from metabolic acidosis and AKI severity in children with DKA. The author Huang and colleagues have conducted research titled “Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis” published in Plos One journal. The summary of the findings is below:
Objectives:
To study the prevalence of AKI along with analyzing its clinical and laboratory markers associated with children and adolescents hospitalized for DKA.
To investigate if there exists an association between AKI severity and recovery time from metabolic acidosis during the treatment course of DKA.
Method:
A retrospective review of medical records of children and adolescents (aged <18 years) diagnosed with type 1 or type 2 diabetes mellitus along with DKA between 2000–2017 at the MacKay Children’s Hospital was conducted. Creatinine level >1.5 times the calculated expected baseline creatinine level was considered as AKI. Depending upon the severity of AKI, patients were divided into three groups: no AKI, mild AKI, and severe AKI.
Findings:
The study reports that 56.5% of children and adolescents with DKA had developed AKI on admission. Furthermore, along with volume-responsive injury and intrinsic renal tubular injury; one-third of children are classified under severe AKI. Newly diagnosed children with diabetes were in higher proportion to develop AKI in this study than previously diagnosed and also repeated DKA episodes may have poor treatment compliance, findings suggest. It is also reported that kidney injury can go unrecognized unless detected by elevated serum creatinine levels. Hence, serum creatinine levels are delayed and insensitive marker of impaired renal function. The study revealed that with an increased decline in eGFR, the time required to recover from metabolic acidosis increases.
The higher levels of blood glucose, higher heart rate, and corrected sodium were associated with the severity of AKI and, this should be assessed especially when children with DKA have metabolic acidosis for a long time. Lastly, findings suggest that volume depletion is the causative aetiology of AKI.
Limitation:
The major limitation acknowledged by authors is the retrospective nature of the study. Due to which results are dependent on the accuracy and completeness of the medical records. The creatinine level that investigators used to calculate eGFR was measured through the Jaffe method. There is a chance that the presence of acetoacetate in children with metabolic ketoacidosis, may have resulted in falsely elevated serum creatinine levels if measured using the Jaffe method.
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