Acute kidney injury and long-term renal outcomes in pediatric diabetic ketoacidosis.

Abstract

Background: The cumulative evidence suggests that children with type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA) have increased risk of acute kidney injury (AKI). However, there is insufficient data among Thai patients, and the available information of long-term renal outcomes is limited.

Objectives: To investigate the proportion and risk factors associated with AKI in children with T1DM and DKA, and to differentiate long-term renal outcomes between those experiencing AKI and those who are unaffected.

Methods: Conducting a retrospective study, we enrolled children aged 1-18 years with T1DM and DKA at university hospital from January 2010 to August 2023. Participants were categorized into two groups based on the presence of AKI according to the 2012 KDIGO guidelines. The clinical parameters associated with these risk factors and long-term renal outcomes were evaluated.

Results: This study included 85 children with T1DM admitted for 122 episodes of DKA, with 46 episodes (37.7 %) experiencing AKI. Identified AKI risk factors during DKA encompassed hypertension (adjusted odds ratio, aOR, 4.36; p = 0.05), serum glucose >500 mg/dL (aOR, 13.7; p < 0.001), WBC counts >15,000 cells/mm3 (aOR, 16.13; p < 0.001), and neutrophil-lymphocyte ratio >5.5 (aOR, 5.29; p = 0.04). For long-term renal outcomes, individuals with AKI during DKA demonstrated higher prevalence of hypertension, microalbuminuria, and abnormal glomerular filtration rates.

Conclusion: AKI was common in children with T1DM experiencing DKA. Of note, it was linked to severe hyperglycemia, leukocytosis, and an elevated neutrophil-lymphocyte ratio, contributing to the deterioration in long-term renal prognosis.