406-P: Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes

Introduction & Objective: Sodium glucose linked transporter inhibitors (SGLTi) in T1D raise DKA risk but hold potential for kidney protection, especially with impaired renal function [eGFR <60 ml/min/1.73m²]. We aimed to determine if those with eGFR impairment have higher DKA risk, perhaps owing to lower buffering capacity, thereby reducing safety of SGLTi use.

Methods: Previously collected data from the DCCT/EDIC Study was obtained through the NIDDK central repository. We assessedtime-varying eGFR over 34 years as exposures and subsequent time-to-first DKA event as the outcome in Cox proportional hazard models.

Results: Of 1441 participants, 297 experienced 488 DKA events over 34-year follow-up. Unadjusted nonlinear association between eGFR categories indicated a “J-shaped” relationship (Figure). Using eGFR of 100 ml/min/1.73m² as the reference, there were no differences in the relative hazard for eGFR ≤ 110 ml/min/1.73m² while eGFR > 110 ml/min/1.73m² had progressively higher risk of DKA. This relationship was only partially explained by covariates in an adjusted model.

Conclusion: Impaired kidney function did not increase DKA risk, implying that use of interventions that increase DKA risk (such as SGLTi) should not cause greater concern than in those with normal eGFR. However, hyperfiltration (eGFR ≈ >120ml ml/min/1.73m²) may impart greater DKA risk and requires further study.

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