Department of Pediatric Nephrology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey.
Ankara Eğitim Ve Araştırma Hastanesi Hacettepe, Mh. Ulucanlar Cd. No:89 Altındağ, Ankara, 06230, Turkey.
Eur J Pediatr. 2024 Oct;183(10):4319-4327. doi: 10.1007/s00431-024-05697-y. Epub 2024 Jul 30.
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Prerenal acute kidney injury (AKI) is associated with profound hypovolemia and reduced renal perfusion. Results regarding hyperchloremia-associated AKI in patients with DKA are conflicting; we therefore investigated the potential relationship between hyperchloremia status and the risk of developing AKI. This single-center cohort study included 113 newly diagnosed T1DM patients with DKA admitted to the pediatric intensive care unit. Laboratory parameters, including Na, K, urea, creatinine, and chloride levels, were retrospectively reviewed at the time of presentation and at 12, 24 and 36 h. AKI was defined using the eGFR according to the pediatric RIFLE classification criteria. Twenty-two (19.5%) of the 113 patients were in the AKI group. Two-way repeated-measures ANOVA showed significant (P values ≤ 0.01) time interaction effects within the groups based on the eGFR and the serum chloride, hyperchloremia, and phosphate levels. Serum chloride levels did not differ between the groups during the first 12 h (p > 0.05) but were significantly greater in the AKI group than in the non-AKI group at 24 h and 36 h (p < 0.01). The final DKA resolution time was significantly greater in the AKI group than in the non-AKI group [22.2 (9.5) vs. 17.0 (12.0) h, respectively; p = 0.03]. However, the groups had similar lengths of hospital stay [13.0 (8.0) days vs. 12.0 (4.0) days, respectively; p = 0.17].Conclusions: Hyperchloremia may be iatrogenic rather than causative during treatment. This may worsen renal failure and prolong the recovery and treatment time for DKA patients. What is Known? • Acute kidney injury resulting from severe volume depletion is a common occurrence in diabetic ketoacidosis and typically requires significant volume replacement therapy. • In recent years, hyperchloremia has been associated with increased risks of AKI, morbidity, and mortality in some conditions, such as diabetic ketoacidosis. What is New? • The incidence of hyperchloremia increases over time during the treatment of diabetic ketoacidosis. • Hyperchloremia may be an iatrogenic element rather than a cause of acute kidney injury during the treatment of diabetic ketoacidosis.
糖尿病酮症酸中毒 (DKA) 是 1 型糖尿病 (T1DM) 的一种危及生命的并发症。急性肾前性肾损伤 (AKI) 与严重低血容量和肾灌注减少有关。关于 DKA 患者中高氯血症相关 AKI 的结果存在争议；因此，我们研究了高氯血症状态与发生 AKI 的风险之间的潜在关系。这项单中心队列研究纳入了 113 例因 DKA 入住儿科重症监护病房的新诊断为 T1DM 的患者。回顾性分析了入院时和 12、24 和 36 小时时的 Na、K、尿素、肌酐和氯水平等实验室参数。根据儿科 RIFLE 分类标准的 eGFR，将 AKI 定义为急性肾损伤。113 例患者中 22 例（19.5%）为 AKI 组。双向重复测量方差分析显示，根据 eGFR 和血清氯、高氯血症和磷酸盐水平，两组内均存在显著的（P 值均≤0.01）时间交互作用效应。在最初的 12 小时内，两组之间的血清氯水平没有差异（p>0.05），但在 24 小时和 36 小时时，AKI 组的血清氯水平显著高于非 AKI 组（p<0.01）。AKI 组的 DKA 最终缓解时间明显长于非 AKI 组[分别为 22.2（9.5）小时和 17.0（12.0）小时；p=0.03]。然而，两组的住院时间相似[分别为 13.0（8.0）天和 12.0（4.0）天；p=0.17]。结论：高氯血症可能是治疗过程中的医源性而非病因。这可能会使肾衰竭恶化，并延长 DKA 患者的恢复和治疗时间。已知的：在糖尿病酮症酸中毒中，严重容量耗竭导致的急性肾损伤是很常见的，通常需要大量的容量替代治疗。近年来，高氯血症与某些疾病（如糖尿病酮症酸中毒）的 AKI、发病率和死亡率的风险增加有关。新的发现：在糖尿病酮症酸中毒的治疗过程中，高氯血症的发生率随时间的推移而增加。高氯血症可能是治疗糖尿病酮症酸中毒过程中的一个医源性因素，而不是急性肾损伤的原因。
