Kidney injury during diabetic ketoacidosis increases risk of future kidney disease

Diabetic kidney disease is a major cause of end-stage kidney failure. Does acute kidney injury during diabetic ketoacidosis in children with type 1 diabetes increase the risk of future kidney disease?

One of the major causes of end-stage kidney failure is diabetic kidney disease. Recent investigations have found that a high frequency of acute kidney injury during diabetic ketoacidosis occurs among children. A new investigation examined the long-term risk of such occurrences on future diabetic kidney disease in children who have type 1 diabetes.1

The investigators performed a retrospective review of medical records that included children with type 1 diabetes who also had 1 or more urine albumin levels that were measured during the course of routine care for diabetes from January 2006 to December 2019. Variables examined included episodes of diabetic ketoacidosis, pH and creatinine levels during diabetic ketoacidosis, hemoglobin A1c, age at diagnosis of type 1 diabetes, and urine albumin and creatinine measurements. Serum creatinine measurements were used to determine acute kidney injury and acute kidney injury stage. For the purpose of the investigation, microalbuminuria was noted as urine albumin–to-creatinine ratio of 30 mg/g or more or excretion of 30 mg or more of albumin in 24 hours.

A total of 2345 were included in the study who had an average age at diagnosis of 9.4 years. At least 1 episode of diabetic ketoacidosis occurred in 963 children. Acute kidney injury during an episode of diabetic ketoacidosis happened in 560 episodes. In models that were adjusted for average hemoglobin A1c level since diagnosis and age at diagnosis, each episode of acute kidney injury during a period of diabetic ketoacidosis were linked to a hazard ratio of 1.56 (95% CI, 1.3-1.87) for development of microalbuminuria. Furthermore, 4 or more episodes of acute kidney injury lead to a more than 5-fold increase in the hazard ratio. Following adjustment for other variables, episodes of diabetic ketoacidosis without the incidence of acute kidney injury were not found to significantly increase the hazard rate for developing microalbuminuria.

The investigators concluded that occurrences of acute kidney injury during bouts of diabetic ketoacidosis had significant links to the risk of microalbuminuria among children who had type 1 diabetes. To reduce this risk, clinicians should strive to reduce the frequency of periods of diabetic ketoacidosis in this patient group.

Reference

1. Piolanti A, Foran HM. Efficacy of interventions to prevent physical and sexual dating violence among adolescents. JAMA Pediatrics. November 29, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.4829