DKA linked to concurrent kidney, brain injury in children
medwireNews: Acute kidney injury (AKI) is common in children with diabetic ketoacidosis (DKA) and is associated with circulatory volume depletion, greater acidosis, and signs of cerebral injury, US study data show.
Sage Myers (Children’s Hospital of Philadelphia, Pennsylvania) and co-investigators say their findings indicate that AKI “may occur as part of a pattern of multiple organ injury involving the kidneys and brain.”
Their results are based on a secondary analysis of data for 1359 DKA episodes requiring intravenous insulin therapy recorded in the PECARN FLUID study, which compared fluid protocols for pediatric DKA in 13 US hospitals.
The DKA episodes occurred among children (mean age 11.6 years) with blood glucose of at least 300 mg/dL and a venous pH below 7.25 or a serum bicarbonate level below 15 mEq/L.
The researchers report in JAMA Network Open that AKI occurred in 43% of DKA episodes and was most commonly present at DKA diagnosis (94.7% of cases).
Over half (56.8%) of the AKI events were stage 1, 36.8% were stage 2, and 6.3% were stage 3.
Multivariable analyses revealed that increasing baseline heart rate (aOR=1.20 per SD increase in z-score), glucose concentration (aOR=1.19 per 100 mg/dL), serum urea nitrogen (aOR=1.14 per 1 mg/dL), age (adjusted odds ratio [aOR]=1.05 per year), and glucose-corrected sodium (aOR=1.03 per 1 mEq/L) were all significantly associated with AKI.
Baseline pH was also associated with AKI, with each 0.1 unit increase associated with a significant 47% decreased risk.
During the DKA episodes, the children underwent short-term memory testing every 4 hours and then took part in an IQ test 2 to 6 months after the episode. The researchers found that the children with AKI had significantly lower short-term memory scores than those without DKA (mean digit span recall: 6.8 vs 7.6) as well as significantly lower mean IQ scores after DKA recovery (100.0 vs 103.5).
Furthermore, the cognitive differences persisted after adjusting for DKA severity and demographic factors, which Myers et al say suggests “that concurrent kidney and cerebral injury were associated with a common process and not simply reflections of a higher risk of injury to both organs in children with more severe DKA.”
The authors conclude: “Future investigations should focus on mechanisms associated with concurrent injury to the kidneys and brain.”
They add: “More clearly defining the mechanisms of kidney injury resulting from DKA could have important implications for the development of new therapeutic and preventive strategies.”
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