METHODS: Retrospective cohort of all DKA inpatients at a tertiary pediatric hospital from 2014 to 2019. A total of 145 children were included; reasons for exclusion were pre-existing kidney disease or incomplete medical records. AKI was determined by change in creatinine during admission, and comparison to a calculated baseline value. Linear regression multivariable analysis was used to identify factors associated with AKI. True dehydration was calculated from patients\' change in weight, as previously validated. Fluid over-resuscitation was defined as total fluids given above the true dehydration.
RESULTS: A total of 19% of patients met KDIGO serum creatinine criteria for AKI on admission. Only 2% had AKI on hospital discharge. True dehydration and high serum urea levels were associated with high serum creatinine levels on admission (p = 0.042; p < 0.001, respectively). Fluid over-resuscitation and hyperchloremia were associated with delayed kidney recovery (p < 0.001). Severity of initial AKI was associated with cerebral edema (p = 0.018).
CONCLUSIONS: Dehydration was associated with initial AKI in children with DKA. Persistent AKI and delay to recovery was associated with hyperchloremia and over-resuscitation with IVF, potentially modifiable clinical variables for earlier AKI recovery and reduction in long-term morbidity. This highlights the need to re-address fluid protocols in pediatric DKA.
方法:回顾性队列研究了2014年至2019年在某三级儿科医院住院的所有DKA患者。共有145名儿童被包括在内;排除的原因是先前存在的肾脏疾病或医疗记录不完整。AKI通过入院时肌酐的变化来确定,并与计算的基线值进行比较。线性回归多变量分析用于确定与AKI相关的因素。真正的脱水是根据患者的体重变化计算的,如先前验证的。液体过度复苏定义为高于真实脱水的总液体。
结果:共有19%的患者在入院时符合KDIGO血清肌酐AKI标准。只有2%的人在出院时出现AKI。真正的脱水和高血清尿素水平与入院时的高血清肌酐水平相关(p=0.042;p<0.001,分别)。液体过度复苏和高氯血症与肾脏延迟恢复有关(p<0.001)。初始AKI的严重程度与脑水肿相关(p=0.018)。
结论:脱水与DKA患儿的初始AKI相关。持续AKI和恢复延迟与高氯血症和IVF过度复苏有关,早期AKI恢复和长期发病率降低的潜在可修改的临床变量。这突出了在儿科DKA中重新处理流体方案的需要。更高分辨率版本的图形摘要可作为补充信息。