Background: Diabetic ketoacidosis (DKA) is managed with insulin and fluids, which can be challenging in patients with CKD. Diabetes is a common cause of CKD.

Objective: To ascertain if patients admitted with DKA with CKD had worse outcomes compared to patients without CKD.

Method: Data were extracted from the Nationwide Inpatient Sample (NIS) Database for 2016 and 2017. The numbers in the database are weighted to optimize national estimates. Hospitalizations involving adults with a principal diagnosis of DKA were included. This group was further categorized based on the presence of CKD as a secondary diagnosis. The primary outcome was inpatient mortality and secondary outcomes were Length of stay (LOS) and Total hospital Charge (THC). Multivariate regression analysis was used to adjust for possible confounders.

Results: There were 245,170 adults who had a principal discharge diagnosis of DKA, of which 22700 had a secondary diagnosis of stage 1-5 CKD or ESRD. Those with CKD were significantly older on average (45.1 vs. 34.7 years) but without sex variation, compared to those without CKD.

A total of 650 inpatient mortality (0.27%) occurred in patients with DKA, 135 occurring in patients with CKD (0.60%). After accounting for age, sex, disease severity and type of diabetes, the adjusted odds ratio (aOR) for mortality in patients with CKD compared to those without CKD was 0.89 (95% CI: 0.511 1.551, p= 0.682). CKD patients had an adjusted increase in total hospital charge of $5970 (95% CI: 2823 - 9116, p<0.001) and adjusted increase in length of hospitalization of 0.6 days ((95% CI: 0.3 - 0.8, p<0.001).

Conclusions: In patients hospitalized with a principal diagnosis of DKA, there was no significant difference in mortality among patients with co-existing CKD. A modest increase in LOS and THC was however noted in those with CKD which was statistically significant. More research needs to be done to elucidate the effect of CKD stages on these outcomes.


H. Shaka: None. E. Edigin: None. T.A. Gomez: None. J. Xu: None. S.T. Yap: None. M. Padilla Sorto: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at