title: Incidence and characteristics of acute kidney injury in severe diabetic ketoacidosis.
abstract: OBJECTIVE
  Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued.
  
  
  METHODS
  Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on admission were searched for.
  
  
  RESULTS
  Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.020-1.100], p<0.01), blood glucose (odds ratio 1.101 [1.039-1.166], p<0.01) and serum protein (odds ratio 0.928 [0.865-0.997], p = 0.04).
  
  
  CONCLUSIONS
  Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admission.
authors.affiliation: Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France; IRCAN, Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Orban
authors.affiliation: Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France.
authors.forename: Eve-Marie
authors.initials: EM
authors.lastname: Maizière
authors.affiliation: Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France.
authors.forename: Anis
authors.initials: A
authors.lastname: Ghaddab
authors.affiliation: IRCAN, Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France; Laboratoire de Biochimie, CHU de Nice, Nice, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Van Obberghen
authors.affiliation: Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France; IRCAN, Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D001786:Blood Glucose; D001798:Blood Proteins / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D001798:Blood Proteins