Acute Kidney Injury in Children with Diabetic Ketoacidosis

Abstract

Backgrounds and Objectives: Diabetic ketoacidosis is frequent in type I diabetic children, and as acute kidney injury has a well-known morbidity, this study aims to determine the frequency and associated factors of acute kidney injury in these children. Material and Methods:  A prospective study conducted on type I diabetic children with diabetic ketoacidosis admitted at Central Child Teaching Hospital; during February 2020 - January 2021. The study includes 96 patients, aged < 15 years. Demographic and clinical information collected for each patient, including ( age, gender, onset of diabetes, previous diabetic ketoacidosis, recurrent urinary tract infection). At admission all patients underwent clinical assessment of their heart rate and amount of resuscitation boluses given; and weight and height measured. PH and HCO3 levels used to categorize diabetic ketoacidosis severity. Kidney Disease Improving Global Outcomes S.creatinine criteria used to identify acute kidney injury. Estimated basal creatinine using modified Schwartz formula, with glomerular filtration rate 120 ml/min/m2 was used. Logistic regression analysis used to identify risk factors. Results:  A total 19 (19.8%) participants developed acute kidney injury(AKI) at 24hrs hospitalization [ 15 (78.9%) cases AKI stage I, 2 (10.5%)cases AKI stage II, and 2 (10.5%)cases AKI stage III ]. One child required peritoneal dialysis at second day of admission. Diabetic ketoacidosis severity odds for AKI reached 5.5 and increased to 13.3 with increasing heart rate. Conclusions:  Acute kidney injury occurred in one in five of children during diabetic ketoacidosis with ketoacidosis severity and high heart rate at admission is an important associated factors.