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Risk factors, outcomes, and predictors of resolution of acute kidney injury in children with diabetic ketoacidosis

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Abstract

Background

Acute kidney injury (AKI) is a common complication in patients with diabetic ketoacidosis (DKA) (incidence 35–77%). AKI evolution during DKA treatment/recovery is poorly understood. Our aim was to assess children with DKA for prevalence, short-term kidney outcomes, severity, and predictors of AKI development and resolution.

Methods

This retrospective cohort study included children aged 2–14 years admitted with DKA between January 2016 and May 2020 in a Saudi tertiary care hospital. We defined AKI as an increase in serum creatinine of > 1.5 times baseline or > 3 mg/dL (26 mmol/L) within 48 h.

Results

Of 213 patients admitted with DKA, 172 (80.75%) developed AKI: stage 1 in 83 (38.96%), stage 2 in 86 (40.37%), and stage 3 in 3 (1.4%). No patient required dialysis. Multivariate analysis showed an increased risk of developing AKI with male gender (OR = 2.85) and lower serum bicarbonate (OR = 0.83) when adjusted for initial heart rate, hematocrit, new onset diabetes, and recurrent AKI. The mean time to AKI resolution was 13.21 ± 6.78 h. Factors leading to prolonged recovery from AKI in linear regression analysis were older age (B coefficient = 0.44, p = 0.01), recurrent DKA episodes (B coefficient = 3.70, p value 0.003), increased acidosis severity (B coefficient =  − 0.44, p = 0.04), increased time to anion gap normalization (B coefficient = 0.44, p = 0.019), and increased initial glucose (B coefficient = 0.01, p = 0.011).

Conclusion

In our cohort, AKI is a common, but mostly transient complication in children presenting with DKA, and its severity is associated with longer intensive care stays and time for acidosis resolution. AKI was associated with male gender, and lower serum bicarbonate. Proper consideration of such risk factors is needed for AKI assessment and management in future DKA clinical practice guidelines.

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Author information

Author notes

  1. Reem Al Khalifah and Ayman Al-Eyadhy contributed equally to this work.

Authors and Affiliations

  1. Endocrine Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Reem Al Khalifah & Ali A. N. Alhaboob

  2. Pediatric Intensive Care Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ayman Al-Eyadhy, Gamal Hassan, Mohamad-Hani Temsah & Ali A. N. Alhaboob

  3. Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Najd Musibeeh, Anfal Alshalawi, Noor Alanazi & Ayman Alhboob

  4. Pediatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt

    Gamal Hassan

  5. Pediatrics Department, Pediatric Intensive Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates

    Gamal Hassan

  6. Department of Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

  7. Nephrology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Khalid Alhasan

  8. Pediatric Kidney Transplant Division, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Khalid Alhasan

Authors
  1. Reem Al Khalifah
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  2. Ayman Al-Eyadhy
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  9. Ali A. N. Alhaboob
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  11. Khalid Alhasan
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Correspondence to Khalid Alhasan.

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Al Khalifah, R., Al-Eyadhy, A., Musibeeh, N. et al. Risk factors, outcomes, and predictors of resolution of acute kidney injury in children with diabetic ketoacidosis. Pediatr Nephrol 38, 573–582 (2023). https://doi.org/10.1007/s00467-022-05578-2

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  • DOI: https://doi.org/10.1007/s00467-022-05578-2

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