Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2673-e2679. doi: 10.1210/clinem/dgab126.
Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß-hydroxybutyrate in patients with ESKD (eGFR < 15 mL/min/1.73 m2), moderate renal failure (eGFR 15-60), or preserved renal function (eGFR > 60).
This observational study included adults (18-80 years) with diabetes ketoacidosis (DKA), admitted to Emory University Hospitals between January 1, 2006 to December 31, 2016. DKA and renal stages were confirmed on admission laboratory values.
Admission bicarbonate levels (13.9 ± 5 vs 13.4 ± 5.3 vs 13.8 ± 4.2 mmol/L, P = 0.7), and pH levels (7.2 ± 0.3 vs 7.2 ± 0.2 vs 7.2 ± 0.2, P = 0.8) were similar among groups. Patients with ESKD had lower mean ß-hydroxybutyrate level (4.3 ± 3.3 vs 5.6 ± 2.9 vs 5.9 ± 2.5 mmol/L, P = 0.01), but higher admission glucose (852 ± 340.4 vs 714.6 ± 253.3 mg/dL vs 518 ± 185.7 mg/dL, P < 0.01), anion gap (23.4 ± 7.6 vs 23 ± 6.9 vs 19.5 ± 4.7 mmol/L, P < 0.01), and osmolality (306 ± 20.6 vs 303.5 ± vs 293.1 ± 3.1mOsm/kg, P < 0.01) compared with patients with moderate renal failure and preserved renal function, respectively. The sensitivity of ß-hydroxybutyrate > 3 mmol/L for diagnosing DKA by bicarbonate level < 15 and <18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure, and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels < 10, 10-15, <18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively.
Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level > 3 mmol/L may assist with confirmation of DKA diagnosis.
终末期肾病（ESKD）患者糖尿病酮症酸中毒（DKA）的生化参数差异尚未确定。因此，我们评估了代谢性酸中毒程度与 ESKD（eGFR < 15 mL/min/1.73 m2）、中度肾功能衰竭（eGFR 15-60）或保留肾功能（eGFR > 60）患者中β-羟丁酸之间的关系。
这项观察性研究纳入了 2006 年 1 月 1 日至 2016 年 12 月 31 日期间在埃默里大学医院就诊的患有糖尿病酮症酸中毒（DKA）的成年人（18-80 岁）。入院实验室值确认 DKA 和肾功能分期。
入院时碳酸氢盐水平（13.9 ± 5 与 13.4 ± 5.3 与 13.8 ± 4.2 mmol/L，P = 0.7）和 pH 值（7.2 ± 0.3 与 7.2 ± 0.2 与 7.2 ± 0.2，P = 0.8）在各组之间相似。ESKD 患者的平均β-羟丁酸水平较低（4.3 ± 3.3 与 5.6 ± 2.9 与 5.9 ± 2.5 mmol/L，P = 0.01），但入院时血糖（852 ± 340.4 与 714.6 ± 253.3 mg/dL 与 518 ± 185.7 mg/dL，P < 0.01）、阴离子间隙（23.4 ± 7.6 与 23 ± 6.9 与 19.5 ± 4.7 mmol/L，P < 0.01）和渗透压（306 ± 20.6 与 303.5 ± 与 293.1 ± 3.1mOsm/kg，P < 0.01）均高于中度肾功能衰竭和保留肾功能患者。β-羟丁酸水平> 3 mmol/L 时，ESKD 患者 DKA 的诊断灵敏度分别为碳酸氢盐水平<15 和<18 mmol/L 的 86.9%和 72%，中度肾功能衰竭患者为 89.3%和 83.7%，保留肾功能患者为 96.2%和 88.3%。在 ESKD 患者中，相应的β-羟丁酸与碳酸氢盐水平<10、10-15 和<18 mmol/L 分别为 5.5、3.9 和 3.0 mmol/L。
不同肾功能水平的 DKA 患者存在显著的代谢差异。在 ESKD 患者中，β-羟丁酸水平> 3 mmol/L 可能有助于确认 DKA 诊断。
