Incidence and characteristics of acute kidney injury in severe diabetic ketoacidosis.

AIMS: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. METHODS: Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on admission were searched for. RESULTS: Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.020-1.100], p<0.01), blood glucose (odds ratio 1.101 [1.039-1.166], p<0.01) and serum protein (odds ratio 0.928 [0.865-0.997], p = 0.04). CONCLUSIONS: Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admission

Proportions of patients with normal renal function and AKI at the three times of the study.

<p>In the AKI patients, RIFLE categories are reported as numbers and percentages of AKI patients.</p><p>Proportions of patients with normal renal function and AKI at the three times of the study.</p

Treatments administered in the population and according to the renal function.

<p>Data are expressed as median and interquartile range.</p><p>Treatments administered in the population and according to the renal function.</p

Baseline clinical and biological characteristics of the patient population with focus on renal function.

<p>Data are expressed as median and interquartile range except for haemodynamic failure expressed as number and percentage.</p><p>Baseline clinical and biological characteristics of the patient population with focus on renal function.</p

Multiple logistic regression model with AKI on admission as the dependent variable.

<p>Multiple logistic regression model with AKI on admission as the dependent variable.</p