Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
PLoS One. 2020 Oct 7;15(10):e0239160. doi: 10.1371/journal.pone.0239160. eCollection 2020.
Diabetic ketoacidosis (DKA) is associated with dehydration and which can cause acute kidney injury (AKI). The proportion of AKI in children and adolescents with DKA has not been reported in East Asian population. This study aimed to identify the prevalence of AKI and to determine whether there is an association between AKI severity and recovery time from metabolic acidosis in children and adolescents with DKA. Medical records of children and adolescents (aged <18 years) presenting with type 1 or type 2 diabetes mellitus and DKA between 2000-2017 at the MacKay Children's Hospital were retrospectively reviewed. AKI was defined by an admission creatinine level >1.5 times the calculated expected baseline creatinine level. Patients were divided into three groups based on AKI severity: no AKI, mild AKI, and severe AKI. In total, 170 (56.5%) patients with DKA presented AKI (mild AKI, 116 [38.5%]; severe AKI, 54 [18.0%]). Heart rate and laboratory parameters related to dehydration, such as corrected sodium level and blood urea nitrogen, were strongly associated with AKI development (P<0.01). Blood pH, plasma glucose, and potassium levels were also associated with AKI. A negative correlation with borderline significance between the estimated glomerular filtration rate (eGFR) and recovery time from metabolic acidosis was observed in the severe AKI group. AKI was highly prevalent in children and adolescents with DKA. An association between AKI and biomarkers indicating dehydration was noted. The recovery time from metabolic acidosis following treatment may be longer in children with a decreased eGFR who present with severe AKI. AKI is a common complication in children with DKA.
糖尿病酮症酸中毒（DKA）与脱水有关，可导致急性肾损伤（AKI）。东亚人群中小儿和青少年 DKA 并发 AKI 的比例尚未报道。本研究旨在确定 AKI 的患病率，并确定 DKA 患儿 AKI 严重程度与代谢性酸中毒恢复时间之间是否存在关联。回顾性分析了 2000-2017 年在麦凯儿童医院就诊的 1 型或 2 型糖尿病合并 DKA 的儿童和青少年的病历。入院肌酐水平超过计算得出的预期基线肌酐水平的 1.5 倍定义为 AKI。根据 AKI 严重程度将患者分为三组：无 AKI、轻度 AKI 和重度 AKI。共有 170 例（56.5%）DKA 患儿并发 AKI（轻度 AKI 116 例[38.5%]；重度 AKI 54 例[18.0%]）。与脱水相关的心率和实验室参数，如校正钠水平和血尿素氮，与 AKI 的发生密切相关（P<0.01）。血 pH 值、血浆葡萄糖和钾水平也与 AKI 相关。重度 AKI 组中，估算肾小球滤过率（eGFR）与代谢性酸中毒恢复时间之间存在负相关，且具有统计学意义。AKI 在 DKA 患儿中很常见。AKI 与提示脱水的生物标志物之间存在关联。在出现严重 AKI 的患儿中，eGFR 降低，代谢性酸中毒恢复时间可能更长。AKI 是 DKA 患儿的常见并发症。
