Alyahyawi Naseem, Alghamdi Dalal, Almahmoudi Ahlam, Sandokji Ibrahim, Bokhari Shatha, Safdar Osama Y, Shalaby Mohammad, Shazly Mohamed, Kari Jameela A
Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
BMC Nephrol. 2025 May 22;26(1):254. doi: 10.1186/s12882-025-04178-0.
Acute kidney injury (AKI) in pediatric patients has been linked to unfavorable short-term and long-term health outcomes. Despite the significance of AKI awareness in children with diabetes mellitus type 1 (T1D), the incidence of AKI in children admitted with diabetic ketoacidosis (DKA) has been under looked.
The primary objective of this study was to investigate the incidence of acute kidney injury (AKI) in pediatric patients hospitalized for diabetic ketoacidosis (DKA), and to identify the clinical and biochemical markers associated with the development of AKI.
A retrospective medical record review was conducted at King Abdulaziz University Hospital, a tertiary hospital in Jeddah, Saudi Arabia. The study included 373 children aged 18 years or younger from 2012 to 2022 with complete medical records available for analysis. We collected baseline and diabetes characteristics, in addition to clinical variables at presentation. Acute kidney injury (AKI) was diagnosed using the serum creatinine criteria established by the kidney disease: Improving Global Outcomes (KDIGO) organization. Descriptive comparisons were performed. Uni- and multivariable logistic regression analyses were employed to identify potential risk factors associated with the development of AKI.
299 patients (80.2%) developed AKI including 98 (26.3%) stage 1, and 118 (31.6%) stage 2 and 83 (22.3%) stage 3. The frequency of AKI was higher in patients with severe DKA (26.9% vs. 19.7%, p=0.01) while in mild DKA the percentage of AKI was less than non-AKI (31.9% vs. 45.1%, p<0.01The median last HbA1C prior to DKA presentation was 12%, and majority (88.2%) had DKA episodes in past. children who developed AKI had a significantly higher median heart rate (120 bpm, IQR 104-138) compared to those without AKI (108 bpm, IQR 98-124, p<0.01). A high percentage of children with AKI had low Glasgow coma scale (<15) compared to non-AKI (5.7% vs. 1.7%) but the difference was not statistically significant (p=0.22). Half of the children presented with DKA had poor outpatient follow up visits. The proven infections were observed in 53 (14.2%) children in DKA. It was higher in non-AKI group compared to AKI group (15.1% vs. 10.8%, p=0.46). At the time of discharge 131 (44%) patients with AKI showed persistent acute kidney disease. We did not observe mortality. Children with AKI had longer hospital stay compared to non-AKI (4 days vs. 3 days, p=0.02). None of the study participant have died during the studied hospital encounters.
Our findings indicate that AKI is common in children admitted with DKA. Longer duration and poor controlled T1D; previous episodes of DKA, severe DKA, infection and higher heart rate are risk factors to develop AKI. At the time of discharge, 131 (44%) patients AKI showed persistent acute kidney disease (AKD). The longer hospital stay in children with AKI highlights the significant morbidity of AKI.
Not applicable.
儿科患者的急性肾损伤（AKI）与不良的短期和长期健康结果相关。尽管1型糖尿病（T1D）患儿对AKI的认识很重要，但因糖尿病酮症酸中毒（DKA）入院的儿童中AKI的发病率一直未得到充分关注。
本研究的主要目的是调查因糖尿病酮症酸中毒（DKA）住院的儿科患者中急性肾损伤（AKI）的发病率，并确定与AKI发生相关的临床和生化标志物。
在沙特阿拉伯吉达的一家三级医院阿卜杜勒阿齐兹国王大学医院进行了一项回顾性病历审查。该研究纳入了2012年至2022年期间373名18岁及以下且有完整病历可供分析的儿童。我们收集了基线和糖尿病特征，以及就诊时的临床变量。使用肾脏疾病：改善全球结果（KDIGO）组织制定的血清肌酐标准诊断急性肾损伤（AKI）。进行了描述性比较。采用单变量和多变量逻辑回归分析来确定与AKI发生相关的潜在危险因素。
299例患者（80.2%）发生了AKI，其中98例（26.3%）为1期，118例（31.6%）为2期，83例（22.3%）为3期。重度DKA患者中AKI的发生率更高（26.9%对19.7%，p=0.01），而轻度DKA中AKI的百分比低于非AKI患者（31.9%对45.1%，p<0.01）。DKA发作前的HbA1C中位数为12%，大多数（88.2%）既往有DKA发作史。发生AKI的儿童的心率中位数（120次/分钟，四分位间距104 - 138）显著高于未发生AKI的儿童（108次/分钟，四分位间距98 - 124，p<0.01）。与非AKI儿童相比，发生AKI的儿童中格拉斯哥昏迷量表评分低（<15）的比例较高（5.7%对1.7%），但差异无统计学意义（p=0.22）。一半出现DKA症状的儿童门诊随访情况不佳。在DKA患儿中观察到53例（14.2%）有确诊感染。非AKI组的感染率高于AKI组（15.1%对10.8%，p=0.46）。出院时，131例（44%）AKI患者仍存在持续性急性肾病。我们未观察到死亡病例。与非AKI儿童相比，AKI儿童的住院时间更长（4天对3天，p=0.02）。在研究的住院期间，没有研究参与者死亡。
我们的研究结果表明，AKI在因DKA入院的儿童中很常见。病程较长且T1D控制不佳；既往有DKA发作史、重度DKA、感染以及心率较高是发生AKI的危险因素。出院时，131例（44%）AKI患者仍存在持续性急性肾病（AKD）。AKI儿童住院时间较长突出了AKI的显著发病率。
不适用。
