Acute Kidney Injury in children with diabetic ketoacidosis at onset and diabetic kidney disease: a case-control study

Abstract

During diabetic ketoacidosis (DKA), acute kidney injury (AKI) may occur.

Objective: To evaluate the association between the presence and severity of AKI during the onset of DKA in patients with type 1 diabetes (T1D) and the development of diabetic kidney disease (DKD).

Patients and Method: Case-control study. Patients with T1D who presented with DKA at onset and later developed DKD were identified from a local database. Controls were T1D patients with DKA at onset but without DKD. The presence of AKI at onset was assessed as a factor associated with DKD. Exclusion criteria included missing critical data in medical records, follow-up shorter than 8 years from the onset, kidney disease of a different etiology, and/or initial treatment at a different center. The outcome measure was renal status (presence or absence of DKD) at 8 years after T1D onset.

Results: Seventeen cases and 42 controls were studied; 22 patients developed AKI. Cases had higher HbA1c levels from the onset (p = 0.004) and a higher frequency (p = 0.001) and severity (p = 0.012) of AKI during DKA. Only AKI (OR 5.4, 95% CI 1.18-24.6; p = 0.02) remained independently associated with DKD.

Conclusion: AKI during the onset of DKA in T1D patients was associated with the development of DKD.