Abstract | INTRODUCTION: METHODS: In this observational study, we used International Classification of Diseases Ninth/Tenth Revision codes to identify adult (aged 18-80 years) patients admitted to Emory University Hospitals between 1 January 2006 and 31 December 2016. DKA and ESRD diagnoses were confirmed by reviewing medical records and by admission laboratory results. RESULTS: Among 307 patients with DKA meeting the inclusion and exclusion criteria, 22.1% (n: 68) had ESRD on hemodialysis and 77.9% (n: 239) had preserved renal function (estimated glomerular filtration rate >60 mL/min/1.73 m2). Compared with patients with preserved renal function, the admission blood glucose was higher (804.5±362.6 mg/dL vs 472.5±137.7 mg/dL) and the mean hemoglobin A1c was lower (9.6%±2.1 vs 12.0%±2.5) in patients with DKA and ESRD, both p<0.001. The rates of hypoglycemia <70 mg/dL (34% vs 14%, p=0.002) and <54 mg/dL (13% vs 5%, p=0.04) were higher in the ESRD group. During hospitalization, more patients with ESRD develop volume overload (28% vs 3%, p<0.001) and require mechanical ventilation (24% vs 3%, p=<0.001). There were no differences in hospital mortality (3% vs 0%, p=0.21), but length of stay (median 7.0 vs 3.0 days, p<0.001) was longer in the ESRD cohort. After adjusting for multiple covariates, patients with DKA and ESRD have higher odds of hypoglycemia (OR 3.3, 95% CI 1.51 to 7.21, p=0.003) and volume overload (OR 4.22, 95% CI 1.37 to 13.05, p=0.01) compared with patients with DKA with preserved renal function. CONCLUSIONS:
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Authors | Rodolfo J Galindo, Francisco J Pasquel, Maya Fayfman, Katerina Tsegka, Neil Dhruv, Saumeth Cardona, Heqiong Wang, Priyathama Vellanki, Guillermo E Umpierrez |
Journal | BMJ open diabetes research & care
(BMJ Open Diabetes Res Care)
Vol. 8
Issue 1
(02 2020)
ISSN: 2052-4897 [Electronic] England |
PMID | 32111715
(Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. |
Chemical References |
- Blood Glucose
- Glycated Hemoglobin A
- hemoglobin A1c protein, human
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Blood Glucose
(analysis)
- Diabetic Ketoacidosis
(complications, mortality)
- Female
- Glycated Hemoglobin
(analysis)
- Hospital Mortality
- Hospitals, University
- Humans
- Hypoglycemia
- Kidney Failure, Chronic
(complications)
- Length of Stay
- Male
- Middle Aged
- Renal Dialysis
- Respiration, Artificial
- Retrospective Studies
- Young Adult
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