diabetic ketoacidosis

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA).


Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal.

In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning.

Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis.

This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria.

As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demonstrating fluid loss in the body) and serum sodium were also related to a more severe kidney injury.

These results have shown that in pediatric patients diagnosed with DKA, special attention must be paid to better management and prevention of AKI, because this population is at a great risk of developing renal impairment due to underlying diabetes.


Written By: Nima Makhdami, M.D.

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