Acute Kidney Injury in Children with Type 1 Diabetes Mellitus Hospitalized for Diabetic Ketoacidosis: A Retrospective Study

Shaila Pachapure; Jasmine Kandagal; Manjunath Revanasiddappa; Kavita Konded

doi:10.15605/jafes.040.02.12

Authors

Shaila Pachapure Jawaharlal Nehru Medical College (KAHER - KLE Academy of Higher Education and Research) https://orcid.org/0000-0002-9328-3024
Jasmine Kandagal Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India https://orcid.org/0000-0001-7471-0433
Manjunath Revanasiddappa Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India https://orcid.org/0000-0003-0102-2693
Kavita Konded Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

DOI:

https://doi.org/10.15605/jafes.040.02.12

Keywords:

diabetic ketoacidosis, acute kidney injury, ketone bodies, hyperchloremia

Abstract

Objectives. Diabetic ketoacidosis (DKA) is the most common initial presentation in children with newly diagnosed type 1 diabetes. Severe dehydration/acidosis, shock at admission, and hyperchloremia contribute to acute kidney injury (AKI). This retrospective study was done to determine the proportion of children hospitalized for DKA who had AKI and to compare clinical parameters between children with DKA and with AKI and without AKI to identify the risk factors associated with AKI.

Methodology. A retrospective review of all DKA admissions with type 1 diabetes was done. AKI was diagnosed as per KDIGO-2012 criteria. The analysis was done using a Chi-square test to assess the association between the status of AKI and other parameters. The Independent t-test was applied for comparison with the mean score between the No AKI / AKI group for numerical variables with normal distribution. A multivariable logistic regression analysis was performed to compare clinical parameters between both groups.

Results. Out of 32 children with DKA, 13 (40.63%) developed AKI. Among them, 9 had AKI at admission and 4 children developed AKI within the first 48 hours of admission. Optimum fluid management resolved AKI in 10 patients, but 3 of them required dialysis. Parameters like higher heart rate (p = 0.0390), higher respiratory rate (p = 0.0402), high leukocyte count (p = 0.0005), severe hyperglycemia (p = 0.0204), severe acidosis (p = 0.0001), hyperchloremia (p = 0.016) and shock at admission (p = 0.0001) were present in children with DKA and AKI.

Conclusion. In our study, a high proportion of children with DKA had AKI, which causes prolonged acidosis and hospital stay. Hence, comparing clinical parameters between both groups helps in identifying risk factors associated with AKI in persons with type 1 diabetes with DKA.

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Author Biographies

Shaila Pachapure, Jawaharlal Nehru Medical College (KAHER - KLE Academy of Higher Education and Research)

Jawaharlal Nehru Medical College (KAHER - KLE Academy of Higher Education and Research), Belagavi, Karnataka, India

Manjunath Revanasiddappa, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

2Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital,
Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

Kavita Konded, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital,
Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

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