Risk Factors and Outcomes of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Background: Acute kidney injury (AKI) in pediatric patients has been linked to unfavorable short-term and long-term health outcomes. Despite the significance of AKI awareness in children with diabetes mellitus type 1 (T1D) , the incidence of AKI in children admitted with diabetic ketoacidosis (DKA) has been under looked. Objectives: The primary objective of this study was to investigate the incidence of acute kidney injury (AKI) in pediatric patients hospitalized for diabetic ketoacidosis (DKA), and to identify the clinical and biochemical markers associated with the development of AKI. Methods: A retrospective medical record review was conducted at King Abdulaziz University Hospital, a tertiary hospital in Jeddah, Saudi Arabia. The study included a total of 373 children aged 18 years or younger from 2012 to 2022 with complete medical records available for analysis. We collected baseline and diabetes characteristics, in addition to clinical variables at presentation. Acute kidney injury (AKI) was diagnosed using the serum creatinine criteria established by the kidney disease: Improving Global Outcomes (KDIGO) organization. Descriptive comparisons were performed. Uni- and multivariable logistic regression analyses were employed to identify potential risk factors associated with the development of AKI. Results: A total of 299 patients (80.2%) developed AKI including 98 (26.3%) stage 1, and 118 (31.6%) stage 2 and 83 (22.3%) stage 3. The frequency of AKI was higher in patients with severe DKA (26.9% vs. 19.7%, p=0.01) while in mild DKA the percentage of AKI was less than non-AKI (31.9% vs. 45.1%, p<0.01) Children with AKI had longer hospital stay compared to non-AKI (4 days vs 3 days , p =0.02). The median last HbA1C prior to DKA presentation was 12%, and majority (88.2%) had DKA episodes in past. children who developed AKI had a significantly higher median heart rate (120 bpm, IQR 104-138) compared to those without AKI (108 bpm, IQR 98-124, p<0.01) . A high percentage of children with AKI had low Glasgow coma scale (<15) compared to non-AKI (5.7% vs. 1.7%) but the difference was not statistically significant( p =0.22). Half of the children presented with DKA had poor outpatient follow up visits. The proven infections were observed in 53 (14.2 %) children in DKA. It was higher in non-AKI group compared to AKI group(15.1% vs 10.8%,p=0.46). Outcome of AKI showed persistent acute kidney disease (AKD) at discharge in 131 (44%) in patients who developed AKI. We did not observe mortality. None of the study participant have died during the studied hospital encounters. Conclusion: Our findings indicate that AKI is common in children admitted with DKA. Longer duration and poor controlled T1D , previous episodes of DKA , Severe DKA , infection and higher heart rate are risk factors to develop AKI The hospital stay was higher in children with AKI highlighting its significant morbidity in Children with AKI