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

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.

Automated summary

The study aimed to evaluate the prevalence, short-term kidney outcomes, severity, and predictors of AKI development and resolution in children with DKA. The findings showed that AKI is a common complication in children with DKA, but mostly transient. The severity of AKI is associated with longer ICU stays and time for acidosis resolution. Male gender and lower serum bicarbonate levels are risk factors for AKI development.