Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies. The objective was to compare acute kidney injury (AKI) between youth with isolated DKA to those with hyperosmolarity and explore associations to risk of AKI.

Methods: Charts were reviewed from 01/20through 12/2020 for youth admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg) . Isolated HHS youth were combined with hyperosmolar DKA for analysis. AKI was defined as elevated creatinine level for age. The total amount of isotonic fluids administered was collected, both given as bolus or continuously within the first 12 hours after DKA and/or HHS confirmation. Identification of patients on an angiotensin-converting enzyme inhibitor (ACEI) was a marker for microalbuminuria.

Results: A total of 369 admissions were included: 334 (90.5%) had isolated DKA, 32 (8.7%) had hyperosmolar DKA, and 3 (0.8%) had isolated HHS. Median age was 14 years (IQR=11.2,16.8) and 60% were female. Ninety-six percent had type 1 diabetes mellitus (DM) ; 4% had type 2 DM. New onset DM accounted for 31% of admissions. More hyperosmolar youth had AKI compared to isolated DKA (63% vs. 15%, p<0.001) . Both received similar total volume of fluids; median was 33.6 ml/kg (IQR=28.0,39.5) for isolated DKA and 38.5 ml/kg (IQR=29.1,45.4) for hyperosmolar (p=0.09) . For each unit increase in serum osmolality, the odds of having AKI increase by a factor of 1. (p<0.001) . The odds of AKI for new onset DM is 0.68 compared to known DM diagnosis (p=0.005) . Of the 17 patients (5%) taking an ACEI during admission, three had AKI.

Conclusions: Higher serum osmolality or new onset DM are associated with increased odds of having AKI. Our findings will be useful to identify youth at risk for AKI and guide interventional studies for those with AKI and hyperosmolarity.


E.Zarse: None. M.Knoll: None. D.D.Williams: None. K.Halpin: None. G.Kallanagowdar: None. S.Tsai: Stock/Shareholder; Dexcom, Inc.

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