Diabetic ketoacidosis (DKA) is relatedto dehydration and can cause acute kidney injury (AKI). The percentage of AKI in children and DKA in adolescents has not been documented in the East Asian population.

The objective of this study is to identify the incidence of AKI and to determine an association between AKI severity and the recovery time in children from metabolic acidosis and adolescents with DKA. Medical records of children and adolescents who were aged <18 years and presented with type 1 or type 2 diabetes mellitus and DKA between 2000-2017 at the MacKay Childrens Hospital were reviewed retrospectively. AKI was defined by creatinine level >1.5 times the calculated projected baseline creatinine level at admission. Patients were divided into three groups according to the AKI severity: no AKI, mild AKI, and severe AKI groups.

Altogether, 170 (i.e. 56.5%) patients with DKA manifested AKI (mild AKI, 38.5%) and severe AKI (18.0%). Heart rate and laboratory parameters were associated with dehydration. Corrected sodium level and blood urea nitrogen were strongly related to AKI development. Also, plasma glucose, blood pHand potassium levels were associated with AKI. A negative association with borderline significance between the estimated glomerular filtration rate (eGFR) and recovery time due to the metabolic acidosis was seen in the severe AKI group.

The study concluded that AKI was highly predominant in children and adolescents with DKA. A relationship between AKI and biomarkers signifying dehydration was distinguished. The recovery time from metabolic acidosis after the treatment might be longer in children with a decreased eGFR who are with severe AKI. Thus, AKI is the most common complication in children with DKA.

Source: Huang SK, Huang CY, Lin CH, et al. Acute kidney injury is a common complication in children and adolescents hospitalized for diabetic ketoacidosis. PLoS One. 2020 Oct 7;15(10):e0239160. doi: 10.1371/journal.pone.0239160. PMID: 33027293.