Glycemic status and hyperchloremia as risk factors for acute kidney injury in children with diabetic ketoacidosis

Abstract Introduction. Acute kidney injury (AKI) is a frequent complication in diabetic ketoacidosis (DKA). OBJECTIVE. To analyze the factors associated with nephrotoxicity in pediatric patients with DKA. Material and methods. We performed a case-control study. Records of patients under 18 years of age with DKA were analyzed from January 2016 to January 2021 at the Hospital General Leon, Guanajuato, Mexico. Those who presented AKI diagnosed with KDIGO criteria were defined as cases and clinical and biochemical data were compared with the group that did not present AKI. Results. Thirty records of patients with DKA were reviewed, of which 15 developed AKI (50%) which on average resolved by the fourth day of treatment. In this group there were higher values ​​of serum chloride (112±4 mEq/L vs. 105±4 mEq/L, p<0.001, power 99%) and glycosylated hemoglobin (HbA1c) (14.2±2.4% vs 11.5±2.4%, p=0.003, power 90%). The ROC curve analysis for serum chlorine and LRA had an area under the curve (AUC) of 0.9 (95% CI 0.69-0.97) with a cut-off point of 110 mEq/L and for HbA1c AUC of 0.8 (95% CI 0.6-0.9) with a cut-off point of 12.9%. The level of HbA1c ≥13% at admission as a risk factor for developing AKI showed an OR of 11 (95% CI 2-60) (p=0.006) and serum chloride ≥110 mEq/L an OR of 42 (95% CI 5 -346) (p=0.0005). Conclusions. Half of the children with DKA had some degree of AKI. Serum chloride level ≥110 mEq/L or HbA1c ≥13% at admission increases the risk of AKI.