Diagnosis (by p-RIFLE and KDIGO) and Risk Factors of Acute Kidney Injury in Pediatric Diabetic Ketoacidosis: A Retrospective Study

Abstract

Background: There are two criteria to diagnose and stage acute kidney injury (AKI) in children: pediatric-Risk, Injury, Failure, Loss (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO). This study aims to find out the extent of agreement in diagnosis (by p-RIFLE and KDIGO) and risk factors of AKI in pediatric diabetic ketoacidosis (DKA).

Materials and methods: A retrospective cohort study involving children aged ≤15 years with DKA was conducted between January 2014 and December 2022. Those with inborn errors of metabolism, septic shock, and urinary tract disease were excluded. The primary outcome was the extent of agreement in diagnosis of AKI by p-RIFLE and KDIGO. The secondary outcomes were staging agreement, risk factors, complications (hypoglycemia, hypokalemia, and cerebral edema), time to resolution of DKA, and hospital and pediatric intensive care units (PICU) stay.

Results: Data from 161 patients were collected. Mean (SD) age was 8.6 (3.7) years. Good agreement between p-RIFLE and KDIGO criteria for diagnosis of AKI was noted at admission (Kappa = 0.71, p ≤ 0.001), at 24 hours (Kappa = 0.73, p ≤ 0.001) and discharge (Kappa = 0.60, p ≤ 0.001), and for the staging of AKI at admission (Kappa = 0.81, p ≤ 0.001) at 24 hours (Kappa = 0.75, p ≤ 0.001) and discharge (Kappa = 0.48, p ≤ 0.001). On multivariate analysis, age (≤5 years: aOR = 3.03, 95% CI 1.04-8.79) is an independent risk factor for AKI at discharge by KDIGO. Cerebral edema (n = 6, 3.7%), hypoglycemia (n = 66, 41%), and hypokalemia (n = 59, 36.6%) were noted. Resolution and stay in PICU and hospitals were longer for patients with AKI.

Conclusion: p-RIFLE and KDIGO criteria showed good agreement in diagnosis and staging of AKI in pediatric DKA.

Keywords: Acute kidney injury; Children; Complications; Diabetic ketoacidosis; Insulin.