背景:大约40%的糖尿病酮症酸中毒(DKA)儿童发展为急性肾损伤(AKI),这增加了慢性肾脏损害的风险。目前,对糖尿病儿童糖尿病相关肾损伤的种族或民族差异的认识有限.了解是否存在这种差异将为解决可能持续到成年的糖尿病护理差异提供基础。Further,目前尚不清楚哪些儿童有发生DKA相关AKI恶化或持续的风险.主要目的是确定种族和民族是否与DKA相关的AKI相关。次要目的是确定与DKA儿童持续AKI相关的因素。
方法:本回顾性研究,多中心,将通过儿科急诊医学合作研究委员会对患有DKA的1型或2型糖尿病儿童进行横断面研究。将包括在2020年1月1日至2023年12月31日期间在参与的急诊科接受治疗的2-18岁儿童。非酮症高血糖-高渗状态或从外部设施转移的儿童将被排除。相关的预测因素是种族和民族。主要结果是AKI的存在,由肾脏疾病定义:改善全球结果标准。次要结果是“持续的”AKI,定义为AKI≥48小时,最后一次肌酐测量未解决的AKI或需要肾脏替代治疗。预测因子之间关联的统计推断(即,种族和族裔)和结果(即,AKI和持续AKI)将使用随机效应回归模型,考虑医院的变异和集群。
背景:明尼苏达州儿童机构审查委员会批准了这项研究。另有12个网站获得了机构审查委员会的批准,所有网站都将在参与之前获得当地批准。结果将在地方或国家会议上发表,并在同行评审的期刊上发表。
BACKGROUND: Approximately 40% of children with diabetic ketoacidosis (DKA) develop acute kidney injury (AKI), which increases the risk of chronic kidney damage. At present, there is limited knowledge of racial or ethnic differences in diabetes-related kidney injury in children with diabetes. Understanding whether such differences exist will provide a foundation for addressing disparities in diabetes care that may continue into adulthood. Further, it is currently unclear which children are at risk to develop worsening or sustained DKA-related AKI. The primary aim is to determine whether race and ethnicity are associated with DKA-related AKI. The secondary aim is to determine factors associated with sustained AKI in children with DKA.
METHODS: This retrospective, multicentre, cross-sectional study of children with type 1 or type 2 diabetes with DKA will be conducted through the Paediatric Emergency Medicine Collaborative Research Committee. Children aged 2-18 years who were treated in a participating emergency department between 1 January 2020 and 31 December 2023 will be included. Children with non-ketotic hyperglycaemic-hyperosmolar state or who were transferred from an outside facility will be excluded. The relevant predictor is race and ethnicity. The primary outcome is the presence of AKI, defined by Kidney Disease: Improving Global Outcomes criteria. The secondary outcome is \'sustained\' AKI, defined as having AKI ≥48 hours, unresolved AKI at last creatinine measurement or need for renal replacement therapy. Statistical inference of the associations between predictors (ie, race and ethnicity) and outcomes (ie, AKI and sustained AKI) will use random effects regression models, accounting for hospital variation and clustering.
BACKGROUND: The Institutional Review Board of Children\'s Minnesota approved this study. 12 additional sites have obtained institutional review board approval, and all sites will obtain local approval prior to participation. Results will be presented at local or national conferences and for publication in peer-reviewed journals.