Almohareb Sumaya N, Aljammaz Norah, Yousif Nada, Sunbul Mayar, Alsemary Raghad, Alkhathran Lama, Aldhaeefi Mohammed, Almohammed Omar A, Alshaya Abdulrahman I
Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Front Endocrinol (Lausanne). 2025 Jan 9;15:1445040. doi: 10.3389/fendo.2024.1445040. eCollection 2024.
The global prevalence of diabetes has been rising rapidly in recent years, leading to an increase in patients experiencing hyperglycemic crises like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Patients with impaired renal function experience a delay in insulin clearance, complicating the adjustment of insulin dosing and elevating hypoglycemia risk. Accordingly, this study aims to evaluate the impact of renal function on the safety and efficacy of insulin use in patients with isolated DKA or combined DKA/HHS.
A retrospective observational study was conducted at King Abdulaziz Medical City, Saudi Arabia, from January 2016 to December 2021. Eligible patients were ≥18 years, had a confirmed diagnosis of isolated DKA or combined DKA/HHS, presented with an anion gap (AG) of ≥ 16 mmol/L, and received insulin either via continuous infusion or as bolus doses. Patients were categorized into normal kidney function and patients with chronic kidney disease (CKD). The primary outcome was to determine the difference in time to close the AG between the two groups. Statistical analyses were performed using SAS® software.
Out of 319 screened patients, 183 patients met the inclusion criteria. The patients were divided into normal kidney function (43.2%) and CKD (56.8%) groups. The average eGFR for patients with normal kidney function was 93.7 ± 32.5 mL/min/1.73m compared to 33.4 ± 14.3 mL/min/1.73m for patients with CKD. The time to close AG was similar between patients in the normal kidney function and CKD groups (22.6 ± 16.0 hours vs. 24.5 ± 17.5 hours, =0.4475). However, the patients' length of stay in hospital (3.4 ± 2.5 days vs. 5.2 ± 4.0 days; =0.0004) and ICU (2.5 ± 1.8 days vs. 4.0 ± 2.8 days; =0.0453) were both significantly longer for patients with CKD. Hypoglycemic events were low in our study with only four documented cases among patients with CKD.
This study provides insights into DKA management and outcomes in patients with normal and impaired renal function. The time required to close AG was comparable between the two groups. Larger, multi-center studies are needed to validate these findings and explore additional factors that may impact the management of DKA in patients with CKD.
近年来，全球糖尿病患病率迅速上升，导致糖尿病酮症酸中毒（DKA）和高渗高血糖状态（HHS）等高血糖危象患者增多。肾功能受损的患者胰岛素清除延迟，使胰岛素剂量调整复杂化，并增加低血糖风险。因此，本研究旨在评估肾功能对单纯DKA或合并DKA/HHS患者胰岛素使用安全性和有效性的影响。
2016年1月至2021年12月在沙特阿拉伯阿卜杜勒阿齐兹国王医疗城进行了一项回顾性观察研究。符合条件的患者年龄≥18岁，确诊为单纯DKA或合并DKA/HHS，阴离子间隙（AG）≥16 mmol/L，并通过持续输注或推注剂量接受胰岛素治疗。患者分为肾功能正常组和慢性肾脏病（CKD）组。主要结局是确定两组之间AG闭合时间的差异。使用SAS®软件进行统计分析。
在319例筛查患者中，183例符合纳入标准。患者分为肾功能正常组（43.2%）和CKD组（56.8%）。肾功能正常患者的平均估算肾小球滤过率（eGFR）为93.7±32.5 mL/min/1.73m²，而CKD患者为33.4±14.3 mL/min/1.73m²。肾功能正常组和CKD组患者的AG闭合时间相似（22.6±16.0小时对24.5±17.5小时，P=0.4475）。然而，CKD患者住院时间（3.4±2.5天对5.2±4.0天；P=0.0004）和入住重症监护病房（ICU）时间（2.5±1.8天对4.0±2.8天；P=0.0453）均显著更长。本研究中低血糖事件发生率较低，CKD患者中仅有4例有记录。
本研究为肾功能正常和受损患者的DKA管理及结局提供了见解。两组之间AG闭合所需时间相当。需要开展更大规模的多中心研究来验证这些发现，并探索可能影响CKD患者DKA管理的其他因素。
