Association of Acute Kidney Injury During Diabetic Ketoacidosis With Risk of Microalbuminuria in Children With Type 1 Diabetes
| Autor: | T. Charles Casper, Sage R. Myers, Lindsey A. Loomba, Janani Ramesh, Casey Pitts, Nicole Glaser, Jia Xin Huang, Nathan Kuppermann |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty endocrine system diseases Diabetic ketoacidosis Adolescent urologic and male genital diseases Diabetic Ketoacidosis Diabetic nephropathy Diabetes mellitus Internal medicine medicine Albuminuria Humans Child Original Investigation Proportional Hazards Models Retrospective Studies Type 1 diabetes Medical Audit business.industry Hazard ratio Acute kidney injury nutritional and metabolic diseases Infant Acute Kidney Injury medicine.disease female genital diseases and pregnancy complications Diabetes Mellitus Type 1 Child Preschool Pediatrics Perinatology and Child Health Microalbuminuria Female business Kidney disease |
| Zdroj: | JAMA Pediatr |
| Popis: | Importance Diabetic kidney disease is among the most important causes of end-stage kidney disease worldwide. Risk factors for diabetic kidney disease remain incompletely defined. Recent studies document a high frequency of acute kidney injury (AKI) during diabetic ketoacidosis (DKA) in children, raising the question of whether these AKI episodes might contribute to future risk of diabetic kidney disease. Objective To determine whether episodes of AKI occurring during DKA in children are associated with increased risk of development of microalbuminuria. Design, setting, and participants This retrospective review of medical records included children with type 1 diabetes with 1 or more urine albumin levels measured during routine diabetes care from 2 university-affiliated urban tertiary children's hospitals in the United States from January 2006 to December 2019. Age at diagnosis of diabetes, hemoglobin A1c levels, episodes of DKA, pH and creatinine levels during DKA, and urine albumin and creatinine measurements were analyzed. Cox proportional hazards regression models were used to identify variables affecting the hazard rate for microalbuminuria development. Analyses began January 2021 and ended May 2021. Exposures Episodes of DKA and episodes of AKI occurring during DKA. Main outcomes and measures AKI occurrence and AKI stage were determined from serum creatinine measurements during DKA using Kidney Disease: Improving Global Outcomes criteria. Microalbuminuria was defined as urine albumin-to-creatinine ratio of 30 mg/g or more or excretion of 30 mg or more of albumin in 24 hours. Results Of 2345 children, the mean (SD) age at diagnosis was 9.4 (4.4) years. One or more episodes of DKA occurred in 963 children (41%), and AKI occurred during DKA in 560 episodes (47%). In multivariable models adjusting for the associations of age at diagnosis and mean hemoglobin A1c level since diagnosis, each episode of AKI during DKA was associated with a hazard ratio of 1.56 (95% CI, 1.3-1.87) for development of microalbuminuria. Four or more episodes increased the hazard rate by more than 5-fold. DKA episodes without AKI did not significantly increase the hazard rate for microalbuminuria development after adjusting for other covariates. Conclusions and relevance These data demonstrate that episodes of AKI occurring during DKA in children with type 1 diabetes are significantly associated with risk of developing microalbuminuria. Greater efforts are necessary to reduce the frequency of DKA. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|