Clinical characteristics and risk factors of acute kidney injury in pediatric diabetic ketoacidosis

Objective To assess the incidence and clinical characteristics of acute kidney injury （AKI） and explore the associated risk factors in type 1 diabetes mellitus （T1DM） children complicated with diabetic ketoacidosis （DKA）. Methods Clinical data of 76 T1DM children presenting with DKA were retrospectively analyzed. According to the incidence of AKI， all patients were divided into the AKI and non-AKI groups. Clinical characteristics of DKA children complicated with AKI were summarized. The differences between two groups were analyzed by independent sample t-test， Mann-Whitney U test or Chi-square test， followed by binary Logistic regression. The associated risk factors were analyzed by the receiver operating characteristic （ROC） curve. Results Among 76 children， AKI occurred during DKA in 22 cases （28.9%）， including 4 cases（18.2%） of mild DKA，2 cases（9.1%） of moderate DKA and 16 cases （72.7%） of severe DKA. Among 22 children， 15 cases （68.2%） were diagnosed with stage 1 AKI， 3 （13.6%） with stage 2 AKI， and 4 （18.2%） with stage 3 AKI， respectively. All patients were treated with fluid infusion and low-dose insulin. Renal function of 18 patients returned to normal within 24 h and within 7 d in 3 cases， and 1 case required dialysis replacement therapy due to progressive exacerbation of AKI. Univariate analysis showed that the older the age of onset of AKI， the higher the blood glucose level， uric acid， serum potassium， serum sodium， albumin， neutrophil percentage， anion gap and hematocrit. Logistic regression analysis indicated that age， blood glucose level， uric acid level and hematocrit were the risk factors for AKI. The critical values of ROC curve were age of≥10.5 years， uric acid level of≥635.1 μmol/L， blood glucose level of≥28.1 mmol/L， and hematocrit of≥41.65%， respectively. Conclusions AKI is a common complication in T1DM children with DKA， and most of them can obtain favorable prognosis. Older children， higher uric acid level， higher blood glucose level and higher hematocrit are risk factors for AKI in DKA children.