Acute Kidney Injury Is A Frequent Complication of Pediatric Diabetic Ketoacidosis Interview with:

Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada

Dr. Panagiotopoulos

Constadina Panagiotopoulos, MD, FRCPC
Department of Pediatrics, Endocrinology & Diabetes Unit
British Columbia Children’s Hospital
Vancouver, British Columbia, Canada What is the background for this study?

Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema.

One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors. What are the main findings?

Response: We found that 64% of children hospitalized with DKA met criteria for acute kidney injury. Serum bicarbonate level < 10 mEq/L and an elevated heart rate were found to be associated with an increased risk of severe acute kidney injury. What should readers take away from your report?

Response: Clinicians should consider AKI as a frequent complication accompanying DKA and should be especially alert to its presence in severe DKA, specifically those patients presenting with severe acidosis and more profoundly volume depleted What recommendations do you have for future research as a result of this study?

Response: We have initiated a second study to understand the long-term impact of AKI in these children with respect to their risk for developing chronic kidney disease over the long term. Is there anything else you would like to add?

Response: From this study, we became aware that recognizing AKI is a challenge and there is a need for nephrology follow-up for these children. This is because serum creatinine needs to be interpreted in the context of a child’s height. Therefore, we are developing a quick reference card so that clinicians are provided with a formula that utilizes the child’s height to determine what their expected normal baseline creatinine would be (i.e. prior to illness), and are also provided with the definitions for different stages of AKI so that they can interpret the current serum creatinine when they present in DKA. This card also provides recommendations for clinical monitoring and management of children with AKI in DKA, and recommendations for when to refer to nephrology. As well, in our diabetes clinic, we have created a computerized system to track the serum creatinine after discharge and flag abnormal values for further assessment and referral to nephrology.

No disclosures Thank you for your contribution to the community.


Hursh BE, Ronsley R, Islam N, Mammen C, Panagiotopoulos C. Acute Kidney Injury in Children With Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis. JAMA Pediatr. Published online March 13, 2017e170020. doi:10.1001/jamapediatrics.2017.0020

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 16, 2017 by Marie Benz MD FAAD