O0496 Oct.4: 6:10pm - Frequency, Risk Factors and Associations of Acute Kidney Injury During Diabetic Ketoacidosis in Children

Sunday, October 4, 2020

6:10 PM – 6:17 PM

Background. Acute kidney injury (AKI) has been described as a complication of diabetic ketoacidosis (DKA) in children. The mechanisms involved in the development of AKI during DKA are unclear.

Objective. To investigate the frequency, and demographic, biochemical, and disease-related factors associated with the development of AKI in children with DKA.

Design/Methods. We performed a secondary analysis of data from the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Study, a prospective, multi-center, randomized clinical trial comparing fluid treatment protocols for children with DKA. 1,389 pediatric DKA episodes from 13 hospitals were included in the PECARN FLUID Study and 1,359 (98%) had sufficient information recorded for inclusion in the current analysis.

Presence or absence, and stage of AKI were determined from serum creatinine measurements according to Kidney Disease: Improving Global Outcomes criteria. We compared DKA episodes with and without AKI, using univariable comparisons and multivariable statistical modeling to explore factors associated with AKI during DKA.

Results. AKI occurred in 584 of 1,359 DKA episodes (43%, 95% CI 40-46%), and 252 of these AKI events (43%, 95% CI 39-47%) were stage 2 or 3.[Table 1] 553 (94.7%) presented with AKI at the time of diagnosis; an additional 22 (3.8%) developed evidence of AKI during treatment. Another 16 (2.7%) had worsening of AKI during treatment. Multivariable analyses identified older age (1.05, CI 1.00-1.09), higher initial BUN (1.14, CI 1.11-1.18), heart rate (1.20, CI 10.9-1.32), glucose-corrected sodium concentration (1.03, CI 1.00-1.06), glucose concentration (1.19, CI 1.07-1.32), and pH (0.63, CI 0.51-0.78) as significantly associated with AKI. Children with AKI had lower scores on tests of short-term memory (digit span recall testing) during DKA, and lower intelligence quotient (IQ) scores 3 to 6 months after recovery from DKA.[Table 2] These differences persisted after adjusting for DKA severity and for demographic factors including socioeconomic status.

Conclusion. AKI during DKA occurs commonly. Furthermore, AKI occurs more frequently in children with greater acidosis and greater circulatory volume depletion. In addition, children with AKI have higher frequencies of subtle cognitive impairment during DKA and deficits in IQ after DKA recovery. These findings suggest that AKI during DKA may be part of a pattern of multiple organ injury involving both kidneys and brain.

Presenting Author(s)

Sage R. Myers

Pediatric Emergency Medicine Attending
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

NG

Nicole S. Glaser

Professor of Pediatrics
UC Davis Health
Sacramento, California
Disclosure: No Financial Relationships Disclosed
Jennifer L. Trainor

Professor of Pediatrics and Medical Education
Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
Hinsdale, Illinois
Disclosure: No Financial Relationships Disclosed
LN

Lise E. Nigrovic

Associate Professor in Pediatrics and Emergency Medicine
Boston Children's Hospital
Boston, Massachusetts
Disclosure: No Financial Relationships Disclosed
AG

Aris Garro

Pediatric Emergency Medicine Attending
Rhode Island Hospital
N. Kingstown, Rhode Island
Disclosure: No Financial Relationships Disclosed
Leah Tzimenatos

Professor, Department of Emergency Medicine
University of California, Davis
Sacremento, California
Disclosure: No Financial Relationships Disclosed
KQ

Kimberly S. Quayle

Pediatric Emergency Medicine Attending
St. Louis Children's Hospital
St. Louise, Missouri
Disclosure: No Financial Relationships Disclosed
MK

Maria Y. Kwok

Pediatric Emergency Medicine Attending
New York Presbyterian Morgan Stanley Children’s Hospital
New York, New York
Disclosure: No Financial Relationships Disclosed
AR

Arleta Rewers

Pediatric Emergency Medicine Attending
Colorado Children’s Hospital
Aurora, Colorado
Disclosure: No Financial Relationships Disclosed
MS

Michael J. Stoner

Section Chief Emergency Medicine, Assistant Professor of Pediatrics
Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed
JS

Jeff E. Schunk

Pediatric Emergency Medicine Attending
University of Utah School of Medicine
Salt Lake City, Utah
Disclosure: No Financial Relationships Disclosed
JM

Julie K. McManemy

Pediatric Emergency Medicine Attending
Texas Children's Hospital
Houston, Texas
Disclosure: No Financial Relationships Disclosed
KB

Kathleen M. Brown

Pediatric Emergency Medicine Attending
Children's National Medical Center
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
AD

Andrew D. DePiero

Attending Physician
Division of Emergency Medicine. Department of Pediatrics. Nemours Alfred I. Hospital For Children.
Wilmington, Delaware
Disclosure: No Financial Relationships Disclosed
CO

Cody Olsen

Biostatician IV
University of Utah
Salt Lake City, Utah
Disclosure: No Financial Relationships Disclosed
TC

T. Charles Casper

Associate Professor, Department of Pediatrics
University of Utah
Salt Lake City, Utah
Disclosure: No Financial Relationships Disclosed
SG

Simona Ghetti

Professor of Psychology
UC Davis
Sacramento, California
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

Nathan Kuppermann

Professor and Chair, Department of Emergency Medicine
University of California, Davis
Sacramento, California
Disclosure: No Financial Relationships Disclosed