Outcomes of diabetic ketoacidosis in adults with end-stage kidney disease: Retrospective study based on a national database

INTRODUCTION: The prevalence of diabetes mellitus (DM) in the United States has steadily increased over the past few decades. End-stage kidney disease (ESKD) and diabetic ketoacidosis (DKA) are among the most common chronic and acute complications of DM. Guidance on the management of DKA in ESKD is limited by lack of evidence. We investigated the in-hospital outcomes of patients hospitalized for DKA with underlying ESKD. Methods: We carried out a retrospective cohort study and utilized the National Inpatient Sample (NIS) database from 2016 to 2018. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) codes were used to identify adults (\u3e18 yrs) diagnosed with DM and ESKD. We compared patients with DKA and ESKD to patients who had DKA with preserved renal function. The primary outcomes were rates of in-hospital mortality and mechanical ventilation. Results:Out of 538,135 patients, 18,685 (3.74%) represented DKA patients with ESKD, and 519,450 (96.53%) represented DKA patients with preserved renal function. DKA with concomitant ESKD was more prevalent in a relatively older population (age\u3e30 yrs) with female predominance (52.4%) (p\u3c0.001). The mean age of males and females in the ESKD group was 46.2 (SD 12.7) and 43.7 (SD 13.6) years respectively. African American race and low socioeconomic status had a higher burden of ESKD. In-hospital mortality rate (adjusted OR= 1.12, p=0.56) and need for mechanical ventilation (adjusted OR= 1.11, p=0.25) did not differ significantly in the two groups but adjusted mean total hospitalization charge ($14,882) and mean length of stay (0.87) at the hospital were significantly higher in patients with DKA and ESRD than in those with preserved renal function. CONCLUSION: DKA is associated with short-term morbidity, increased length of stay, and cost of hospitalization. There is a dearth of evidence-based guidance regarding DKA management in CKD and ESRD. Further studies looking into measures in the management of DKA in ESRD will help develop guidelines in management, decreasing morbidity, and cost of hospitalization

Comparative study of cardiac autonomic status by heart rate variability between under-treatment normotensive and hypertensive known type 2 diabetics

Background: Co-existence of hypertension is known in three quarter of Indian type 2 diabetics, this duo having adverse additive effect on cardiovascular health including dysautonomia. Latter can be measured by simple 5 min heart rate variability (HRV) using simple electrocardiogram, which if reduced indicates cardiac risk. Objective: We compared HRV parameters between hypertensive and normotensive type 2 diabetics, looking for significant difference if any. Materials and methods: 98 hypertensive and 40 normotensive type 2 diabetics treated as outpatients were evaluated for disease control and risk stratification. Five min resting HRV was measured by Variowin HR, software based instrument, using standard protocols to record time domain, frequency domain and Poincare plot parameters. They were compared between groups for difference. Results: Mean age was 56 and 51 years, duration 6 years and 4 years respectively in hypertensive (HT) and normotensive (NT) group of type 2 diabetics, which did not significantly differ in distribution of risk factors. There was poor glycaemic control (one third) in both groups and good pressure control in HT group. Both groups revealed all reduced HRV parameters with significant difference in-between only for LF/HF ratio (1.29 in HT vs 2.61 in NT group). Conclusion: Our findings of HRV suggest that in type 2 diabetics with poor glycaemic and good pressure control, hypertension as a co-existing factor does not make significant difference in cardiac dysautonomia emphasizing residual risk despite antihypertensive treatment and need for early HRV screening, strict glycaemic control and other interventions

Impact of disease control and co-existing risk factors on heart rate variability in Gujarati type 2 diabetics: An observational study

Background: Type 2 diabetes mellitus (T2DM) is a proven threat of cardiac dysautonomia with paucity of studies from India. Poor disease control makes it further worse with co-existence of hypertension in majority. Heart rate variability (HRV) is a validated noninvasive tool to assess cardiac autonomic status. Aim: We studied HRV parameters of type 2 diabetics looking for effects of disease control and other co-existing risk factors. Materials and Methods: Ninety-eight hypertensive and forty normotensive under–treatment, Gujarati type 2 diabetics were evaluated for disease control and risk stratification. Five minutes resting, HRV was measured by Variowin HR, software-based instrument, using standard protocols to record time domain, frequency domain, and Poincare plot HRV parameters. They were compared between subgroups for the difference with P< 0.05 defining statistical significance. Results: All HRV parameters were reduced in type 2 diabetics, having mean age 56 years, mean duration 6 years with poor glycemic but comparatively better pressure control. HRV parameters were significantly not different in good compared to poor glycemics or in subjects with optimum pressure control than those without it. Results did not differ significantly, by the presence of individual cardiovascular risk factor in diabetics except resting heart rate. Conclusion: Our findings of HRV suggest that type 2 diabetics with poor glycemic control do not have a significant difference of cardiac dysautonomia by pressure control, glycemic control, and absence of risk cardiovascular factor. It suggests diabetes as a major cause for cardiac dysautonomia, residual risk despite treatment and need for HRV screening, strict glycemic control, and further studies