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Frequency and Risk Factors of Acute Kidney Injury During Diabetic Ketoacidosis in Children and Association With Neurocognitive Outcomes
- Source :
- JAMA Network Open
- Publication Year :
- 2020
- Publisher :
- American Medical Association (AMA), 2020.
-
Abstract
- Key Points Question What are the mechanisms, risk factors, and outcomes associated with acute kidney injury (AKI) during pediatric diabetic ketoacidosis (DKA)? Findings In this cohort study using data from 1359 DKA episodes in a large, multicenter, prospective study of fluid treatment during DKA, AKI occurred in 43% of episodes and was associated with greater acidosis and greater circulatory volume depletion. Children who had AKI were more likely to have subtle cognitive impairment during DKA and lower IQ at longer-term follow-up. Meaning These findings suggest that AKI is frequent in pediatric DKA and there is a pattern of multiorgan dysfunction during childhood DKA with the possibility of common pathophysiologic mechanisms.<br />This cohort study examines the mechanisms, risk factors, and outcomes associated with acute kidney injury during pediatric diabetic ketoacidosis.<br />Importance Acute kidney injury (AKI) occurs commonly during diabetic ketoacidosis (DKA) in children, but the underlying mechanisms and associations are unclear. Objective To investigate risk factors for AKI and its association with neurocognitive outcomes in pediatric DKA. Design, Setting, and Participants This cohort study was a secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a prospective, multicenter, randomized clinical trial comparing fluid protocols for pediatric DKA in 13 US hospitals. Included DKA episodes occurred among children age younger than 18 years with blood glucose 300 mg/dL or greater and venous pH less than 7.25 or serum bicarbonate level less than 15 mEq/L. Exposures DKA requiring intravenous insulin therapy. Main Outcomes and Measures AKI occurrence and stage were assessed using serum creatinine measurements using Kidney Disease: Improving Global Outcomes criteria. DKA episodes with and without AKI were compared using univariable and multivariable methods, exploring associated factors. Results Among 1359 DKA episodes (mean [SD] patient age, 11.6 [4.1] years; 727 [53.5%] girls; 651 patients [47.9%] with new-onset diabetes), AKI occurred in 584 episodes (43%; 95% CI, 40%-46%). A total of 252 AKI events (43%; 95% CI, 39%-47%) were stage 2 or 3. Multivariable analyses identified older age (adjusted odds ratio [AOR] per 1 year, 1.05; 95% CI, 1.00-1.09; P = .03), higher initial serum urea nitrogen (AOR per 1 mg/dL increase, 1.14; 95% CI, 1.11-1.18; P
- Subjects :
- Male
medicine.medical_specialty
endocrine system diseases
Adolescent
Diabetic ketoacidosis
Neurocognitive Disorders
urologic and male genital diseases
Diabetic Ketoacidosis
Cohort Studies
chemistry.chemical_compound
Risk Factors
Diabetes mellitus
Hypovolemia
Internal medicine
medicine
Humans
Child
Original Investigation
Intelligence Tests
Creatinine
business.industry
Research
Acute kidney injury
nutritional and metabolic diseases
General Medicine
Odds ratio
Acute Kidney Injury
medicine.disease
female genital diseases and pregnancy complications
United States
Online Only
chemistry
Child, Preschool
Emergency Medicine
Female
medicine.symptom
business
Kidney disease
Cohort study
Subjects
Details
- ISSN :
- 25743805
- Volume :
- 3
- Database :
- OpenAIRE
- Journal :
- JAMA Network Open
- Accession number :
- edsair.doi.dedup.....4b134cb322e0636f1d73cac48a72e8a4