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Acute Kidney Injury In Dka

Many Children In Dka Experience Acute Kidney Injury

Many Children In Dka Experience Acute Kidney Injury

Kidney disease is often viewed as a potential long-term complication for Type 1 diabetes. A new study suggests, however, that even a single bout of diabetic ketoacidosis (DKA) may injure the kidneys of children. For the study, researchers with the University of British Columbia and British Columbia Childrens Hospital reviewed the medical records of 165 children with Type 1 diabetes who had been hospitalized for DKA. Out of this group, 106 children were found to also have experienced acute kidney injury, with two children needing dialysis to treat the condition, according to findings published in JAMA Pediatrics. Acute kidney injury was diagnosed using a blood test to measure the buildup of creatinine, a waste product expelled by the kidneys. Learn more about DKA by reading the article How DKA Happens and What to Do About it. National Kidney Foundation, acute kidney injury can be asymptomatic or have a variety of symptoms. Potential symptoms can include a decrease in urination, swelling around legs, ankles, and eyes, fatigue, and chest pain. While acute kidney injury often can be effectively treated in the hospital, its considered a risk factor for future stroke, heart disease, and kidney disease; acute kidney injury even ups the risk of future acute kidney injury. The National Kidney Foundation recommends that those who experience acute kidney injury should inform their healthcare providers about it so they can screen kidney health and function. To do this, though, the injury must be properly diagnosed at the time it occurs. Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

1 King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia, Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada, Canada 2 Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada Click here for correspondence address and email Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA. How to cite this article: Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009;20:831-4 Diabetic ketoacidosis (DKA) occurs in 10 to 70% of children with type 1 diabetes mellitus (DM1) and has a significant risk of mortality, mostly due to cerebral edema. [1] Other potential complications of DKA include hypokalemia, hypophosphatemia, hypoglycemia, intracerebral and peripheral venous thrombosis, mucormycosis, rhabdomyolysis, acute pancreatitis, acute renal failure (ARF) and sepsis. The development of ARF with rhabdomyolysis is a rare but potentially lethal diso Continue reading >>

Severe Diabetic Ketoacidosis – A Remarkable Case Study

Severe Diabetic Ketoacidosis – A Remarkable Case Study

Summarized from Van de Vyver C, Damen J, Haentjens C et al. An exceptional case of diabetic ketoacidosis. Case Reports in Emergency Medicine 2017. Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes caused by insulin deficiency. It is characterized by raised blood glucose (hyperglycemia), metabolic acidosis, and increased blood/urine ketones. Dehydration and electrolyte disturbance are common and affected patients may develop some degree of acute kidney injury (AKI) consequent on fluid loss (hypovolemia) due to osmotic diuresis associated with severe hyperglycemia. DKA evolves rapidly over a short time frame (hours rather than days) and can occur (rarely) in those with type 2 diabetes. This DKA case study is particularly noteworthy because of the severity of the hyperglycemia and acid-base disturbance, and the fact that the patient survived such profound metabolic disturbance and associated life-threatening hemodynamic changes. The case concerns a 33-year-old woman with ”brittle” type 1 diabetes treated with continuous subcutaneous insulin infusion (insulin pump). She had, in common with many brittle diabetics, a history of gastroparesis (delayed stomach emptying). Some 36 hours prior to emergency hospital admission she complained of abdominal pain and vomiting after attending a party. Her condition deteriorated before transfer to hospital. The ambulance team reported a rapid decline in Glasgow Coma Score (GCS) from 13 to 3 in only 10 minutes, sinus tachycardia, undetectable peripheral pulse, and hypotension (BP 99/52 mmHg). Clinical examination revealed severe dehydration and respiratory distress (respiration rate 40 breaths/min). Urgent intubation was necessary and systolic blood pressure dropped further to 55 mmHg. Continue reading >>

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Abstract: Importance Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined. Objectives To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI. Design, Setting, and Participants This medical record review of all DKA admissions from September 1, 2008, through December 31, 2013, was conducted at British Columbia Children’s Hospital, the tertiary pediatric hospital in British Columbia, Canada. Children aged 18 years or younger with type 1 diabetes and DKA and with complete medical records available for data analysis were included (n = 165). All data collection occurred between September 8, 2014, and June 26, 2015. Data analysis took place from August 25, 2015, to June 8, 2016. Main Outcomes and Measures Acute kidney injury was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Multinomial logistic regression was used to identify potential factors associated with AKI. Results Of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI (AKI stage 1, 37 [34.9%]; AKI stage 2, 48 [45.3%]; and AKI stage 3, 21 [19.8%]). Two children required hemodialysis. In the adjusted multinomial logistic regression model, a serum bicarbonate level less than 10 mEq/L (compared with ≥10 mEq/L) was associated with a 5-fold increase in the odds of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). Each increase of 5 beats/min in initial heart rate was associated with a 22% increase in the odds of severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). Initial corrected sodium leve Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Go to: Introduction The incidence of diabetes mellitus is increasing worldwide affecting both types of the disease. The most frequent acute diabetic complications are hyperglycemic crises, namely diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. Diabetic ketoacidosis results from an absolute insulin deficiency. Classical presentation associates a triad of uncontrolled hyperglycemia, metabolic acidosis and high ketone bodies concentration. Similarly to diabetes, the incidence of DKA increases over time [1], [2]. This may be a life-threatening condition due to severe clinical and biological impairments and treatment associated complications (cerebral edema, acute respiratory distress syndrome, hypokalaemia, hypophosphatemia). However, mortality is low and most of the time, death is related to the precipitating factor [3]–[6]. For this reason, admission of these patients in ICU is still debated. A grading system for severity of DKA was described previously [7]. Patients presenting the most severe grades or common severity criteria were considered for ICU admission. However this grading system is not recommended for clinical practice, resulting in wide variations in ICU utilisation for DKA, depending on the national practices, the number of DKA admitted in the units and the severity of the clinical status [8]. Interestingly, in the absence of randomised trials, there are no data showing any impact of the level of care on DKA mortality. To help clinicians, guidelines for DKA management are published and updated by the American Diabetic Association [6]. Their effect on clinical outcome is unclear as compliance to guidelines is poor in diabetes care and ICU [9], [10]. However, implementation of a local mandatory protocol seems more efficient to decrease ICU a Continue reading >>

Overview Of The Management Of Acute Kidney Injury In Adults

Overview Of The Management Of Acute Kidney Injury In Adults

INTRODUCTION Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). This results in an elevation of serum blood urea nitrogen (BUN), creatinine, and other metabolic waste products that are normally excreted by the kidney. The term AKI, rather than acute renal failure (ARF), is increasingly used by the nephrology community to refer to the acute loss of kidney function. This term also highlights that injury to the kidney that does not result in "failure" is also of great clinical significance. In this topic review, the acute loss of kidney function will be referred to as AKI. The initial assessment of patients with AKI and management of the major complications of AKI are discussed here. The incidence, causes, diagnosis, and prevention of AKI are presented separately. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Kidney and patient outcomes after acute kidney injury in adults" and "Possible prevention and therapy of ischemic acute tubular necrosis".) PATHOGENESIS AKI has multiple possible etiologies. Among hospitalized patients, AKI is most commonly due to either prerenal etiologies (volume depletion, "third spacing," effective volume depletion from heart failure or cirrhosis) or acute tubular necrosis (ATN) from ischemia, nephrotoxin exposure, or sepsis [1]. The pathogenesis of ATN is discussed elsewhere. (See "Pathogenesis and etiology of ischemic acute tubular necrosis" and "Pathogenesis, clinical features, and diagnosis of contrast-induced nephropathy".) Other frequent causes of AKI among either ambulatory or hospitalized patients include volume depletion, urinary obstruction, rapidly progressive glomerulonephritis, and acute interstitial nephritis. The path Continue reading >>

Aki Seen In 64% Of Children Hospitalized With Diabetic Ketoacidosis

Aki Seen In 64% Of Children Hospitalized With Diabetic Ketoacidosis

AKI seen in 64% of children hospitalized with diabetic ketoacidosis Implications for fluid management in children with AKI With the lack of targeted therapies to prevent AKI or decrease its associated consequences, supportive care is the mainstay of treatment and focuses on fluid and electrolyte management, nutrition, prevention of further injury through close attention to medication dosing, and, when needed, renal replacement therapy. At first glance, these findings may not appear to be overly surprising or significant; children with volume depletion have decreased renal blood flow, leading to AKI, which corrects with fluid administration. However, the authors appropriately suggest that this issue is not a simple one and that fluid management should be carefully considered in these patients. Because of severe hyperglycemia and derangements in serum sodium concentration, children with DKA are at risk of potentially catastrophic cerebral edema, leading to recommendations for cautious administration of fluids in this high-risk population. These findings may lead clinicians and investigators to question established practices related to aggressive fluid administration in the sickest children. While awaiting more research to determine the sweet spot for fluid management in children with AKI, it seems reasonable to give fluids to patients with AKI secondary to volume depletion while quickly shifting to more restrictive strategies in those who do not respond to volume and have decreasing urine output. This may be especially important for children with DKA, as conservative fluid management may decrease central nervous system complications. We commend the authors for exploring AKI in a novel pediatric population, expanding our knowledge on whom kidney function should be more di Continue reading >>

G575(p)acute Kidney Injury And Diabetic Ketoacidosis; Intravenous Fluids Or Ph The Culprit? | Archives Of Disease In Childhood

G575(p)acute Kidney Injury And Diabetic Ketoacidosis; Intravenous Fluids Or Ph The Culprit? | Archives Of Disease In Childhood

G575(P) Acute kidney injury and diabetic ketoacidosis; intravenous fluids or ph the culprit? BRITISH SOCIETY FOR PAEDIATRIC ENDOCRINOLOGY AND DIABETES G575(P) Acute kidney injury and diabetic ketoacidosis; intravenous fluids or ph the culprit? 1Medical School, University of Nottingham, Nottingham, UK 2Department of Paediatric Endocrinology and Diabetes, Nottingham Childrens Hospital, Nottingham, UK Aims The aim of this study is to assess the influence of intravenous (IV) fluid regimens and blood pH on the incidence of acute kidney injury (AKI) in paediatric diabetic ketoacidosis (DKA). This is in light of recent studies raising concerns around this topic, and the 2015 update of the British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines for the management of paediatric DKA, which recommended a substantial reduction in fluid volumes given during DKA treatment. Method The following data was collected from patients under the age of 18, who were admitted to a childrens hospital with DKA from 2010 to 2018; volume of IV fluid received during admission (ml/kg/day), blood pH on admission, and the second creatinine level following admission. The sample was then divided into those who had AKI, and those who did not. AKI was defined by a second creatinine reading 1.5 times greater than the upper limit for their respective age group and gender. Results 74 patients were included in the sample, 14 of whom had AKI. The mean volume of IV fluid received in patients with AKI was 65.7 ml/kg/day, compared with 52.5 ml/kg/day in the patients without AKI. A chi-squared test was performed to explore the difference between the volume of IV fluid given (ml/kg/day) between patients with AKI and those without; a p-value of 0.078 was generated. The mean blood pH of patients w Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Endocrine Abstracts (2015) 39 EP55 | DOI: 10.1530/endoabs.39.EP55 Acute kidney injury as a severe complication of diabetic ketoacidosis Alagusutha Jeyaraman1, Verghese Mathew1, Eric Finlay2 & Sanjay Gupta1 Author affiliations View ePoster Download ePoster 1Hull Royal Infirmary, Hull, UK; 2General Infirmary, Leeds, UK. Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be v Continue reading >>

Children With Type 1 Diabetes At Risk Of Acute Kidney Injury Following Dka

Children With Type 1 Diabetes At Risk Of Acute Kidney Injury Following Dka

A new study has found that children with type 1 diabetes (T1D) who are hospitalised for Diabetic Ketoacidosis (DKA) are more likely to develop acute kidney injury (AKI), a sudden episode of renal failure or damage. DKA is a severe complication that occurs with prolonged hyperglycaemia. It may occur at the initial presentation of newly diagnosed T1D or in someone with pre-existing T1D in times of illness or insulin omission. This is concerning because AKI is associated with increased morbidity and mortality as well as increased risk of chronic renal disease. This is especially relevant among children who are already at risk for diabetic nephropathy. This study, published in JAMA Paediatrics investigated the medical records of 165 children hospitalised for DKA at British Columbia Children’s Hospital in Canada. Of the 165 children hospitalised for DKA, 106 (64.2%) developed AKI (AKI stage 1, 37 [34.9%]; AKI stage 2, 48 [45.3%]; and AKI stage 3, 21 [19.8%]). Two children required haemodialysis. This study is the first to date to document that a high proportion of children hospitalised for DKA develop AKI. In Australia almost 6000 people, half under age 25, were hospitalised due to T1D related DKA in 2014-2015. DKA that occurs in people with undiagnosed T1D could be prevented through the earlier detection of type 1 diabetes at its onset. This study highlights the already urgent need for strategies that improve early diagnosis of T1D. A recent study from US/Europe highlighted the benefits of early diagnosis of T1D. They found no DKA, increased endogenous production of insulin and reduced insulin needs for the first year post diagnosis in those diagnosed early. In Australia, the Environmental Determinants of Islet Autoimmunity (ENDIA) study is investigating factors in the en Continue reading >>

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Volume 2018 |Article ID 4132738 | 3 pages | Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of ,1 Bhavika Gandhi,1 Steven Torre,1 Alireza Amirpour,1 Jennifer Cheng,2 Mayurkumar Patel,1 and Mohammad A. Hossain1 1Department of Medicine, Internal Medicine Residency Program, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA 2Endocrine Service, Nephrology Service, Hackensack Meridian Health Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency. Rhabdomyolysis is a syndrome caused by muscle Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were Continue reading >>

Acute Kidney Injury Frequent In Kids With Diabetic Ketoacidosis

Acute Kidney Injury Frequent In Kids With Diabetic Ketoacidosis

Acute Kidney Injury Frequent in Kids With Diabetic Ketoacidosis Of children with type 1 diabetes who were hospitalized for diabetic ketoacidosis (DKA), 64% developed acute kidney injury (AKI), according to a new study published online March 13 2017 in JAMA Pediatrics. The work is the first to show that acute kidney injury is a frequent complication of pediatric DKA. The latter can be life-threatening and represents the leading cause of hospitalization in youth with type 1 diabetes. This high percentage is concerning because acute kidney injury is associated with increased morbidity and mortality. Studies have also suggested that it may increase the risk of later chronic kidney disease, a condition for which youngsters with type 1 diabetes are already at increased risk. Results also showed that patients with severe acidosis and profound volume depletion were at increased risk of severe acute kidney injury. In DKA, high blood glucose levels can lead to increased urination and volume depletion. Patients also have acidosis and increased production of ketoacids. "On presentation to the hospital, many children with DKA present quite volume depleted, but fluid management" must by necessity be a fine balancing act "because of the risk for cerebral edema," which represents the most serious complication of DKA and can lead to death, senior author Dina Panagiotopoulos, MD, of the University of British Columbia, Vancouver) told Medscape Medical News via email. Acidosis, Tachycardia, Hypernatremia Associated With AKI For the study, the Canadian doctors reviewed the medical records of 165 youth aged 18 years and younger with type 1 diabetes admitted for DKA to British Columbia Children's Hospital in Vancouver between September 2008 and December 2013. They defined acute kidney injury Continue reading >>

Acute Kidney Injury Common In Pediatric Diabetic Ketoacidosis

Acute Kidney Injury Common In Pediatric Diabetic Ketoacidosis

medwireNews: Almost two-thirds of children hospitalized with diabetic ketoacidosis (DKA) develop acute kidney injury (AKI) within 24 hours of hospitalization, study findings indicate. The most severe cases of AKI (stage 2 or 3) were significantly associated with increased volume depletion and more severe acidosis, the researchers report. “Overall, these data suggest that clinicians should consider AKI as a frequent complication that accompanies pediatric DKA and should be especially alert to its presence in severe presentations of DKA,” Constadina Panagiotopoulos (University of British Columbia, Vancouver, Canada) and co-authors write in JAMA Pediatrics. They reviewed the medical records of 165 children (median age 10.6 years) with type 1 diabetes who were hospitalized for diabetic ketoacidosis between 2008 and 2013, 75.8% of whom were newly diagnosed with type 1 diabetes during their stay. Of these, 106 (64.2%) met the Kidney Disease/Improving Global Outcomes serum creatinine criteria for AKI, of which 34.9% was stage 1, 45.3% stage 2, and 19.8% stage 3. In 99.1% of cases, AKI occurred within 24 hours of hospitalization, and it resolved with conservative fluid management by 72 hours in just over half (50.9%) of the patients. Forty patients were admitted to pediatric intensive care overall, and 85.0% of these developed AKI, compared with 57.6% of the 125 treated on a general pediatric ward. Two children required hemodialysis but none died. Panagiotopoulos and team suggest that the high rate of AKI among the children admitted to intensive care “is associated with the severe intravascular depletion inherent in more severe cases of DKA.” They add: “This theory is supported by our study findings that clinical markers of volume depletion, specifically, elevated hea Continue reading >>

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Infection is the most common predisposing factor for diabetic ketoacidosis (DKA); however, studies are rare that have investigated the clinical outcomes of septic patients with infection-precipitated DKA. A retrospective cohort study was conducted at a tertiary hospital from 2004 to 2013. Patients with DKA in whom the presence of a predisposing infection was confirmed were enrolled. Characteristics at initial presentation, primary infection sources, and causative microorganisms were compared between the nonacute kidney injury (non-AKI) group and acute kidney injury (AKI) group at each stage. Risk factors for the development of failure-stage AKI and its outcomes were also analyzed. One hundred and sixty DKA episodes were assessed. The most common infection sites were the urinary and respiratory tracts. The leading causative microorganism was Escherichia coli, followed by Klebsiella pneumoniae. A complicated/severe infection state [odds ratio (OR), 15.27; p < 0.001] and a high level of C-reactive protein (OR, 1.012; p < 0.001) were independently associated with bacteremia. Corrected sodium (Na; OR, 1.062; p = 0.039), initial plasma glucose (OR, 1.003; p = 0.041), severe grade of DKA (OR, 13.41; p = 0.045), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.08; p = 0.033) were identified as independent risk factors for the development of failure-stage AKI among septic patients with infection-precipitated DKA. Patients with failure-stage AKI had a higher frequency of incomplete recovery of renal function (20.4% of patients in failure vs. 5.9% of patients in risk and injury, p = 0.009). Bacteremia independently predicted the absence of complete recovery of renal function (OR, 5.86; p = 0.038). For patients with infection-precipitated DKA, the cli Continue reading >>

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