Acute Kidney Injury Common in Children With Diabetic Ketoacidosis

MONDAY, Dec. 14, 2020 — For children with diabetic ketoacidosis (DKA), acute kidney injury (AKI) is common and is associated with cognitive issues, including lower scores on tests of short-term memory, according to a study published online Dec. 4 in JAMA Network Open.

Sage R. Myers, M.D., from the Children’s Hospital of Philadelphia, and colleagues examined risk factors for AKI and its association with neurocognitive outcomes in pediatric DKA. A total of 1,359 DKA episodes were included for children aged younger than 18 years; episodes with and without AKI were compared.

The researchers found that AKI occurred in 584 episodes (43 percent); 252 AKI events (43 percent) were stage 2 or 3. In multivariable analyses, variables associated with AKI included older age (adjusted odds ratio [AOR] per one year, 1.05), higher initial serum urea nitrogen (AOR per 1 mg/dL increase, 1.14), higher heart rate (AOR per 1-standard deviation increase in z-score, 1.20), higher glucose-corrected sodium (AOR per 1 mEq/L increase, 1.03), glucose concentrations (AOR per 100 mg/dL increase, 1.19), and lower pH (AOR per 0.1 increase, 0.63). Compared to those without, children with AKI had lower scores on tests of short-term memory during DKA and lower mean IQ scores three to six months after recovery from DKA.

“More clearly defining the mechanisms of kidney injury resulting from DKA could have important implications for the development of new therapeutic and preventive strategies,” the authors write.

One author disclosed receiving fees from InsuCalc.

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