Biochemical Parameters of Diabetes Ketoacidosis in patients with End-Stage Kidney Disease and Preserved Renal Function.

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Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß -hydroxybutyrate in patients ESKD (eGFR <15 mL/min/1.73 m 2), moderate renal failure (eGFR 15-60) or preserved renal function (eGFR >60).This observational study included adults (18-80 years) with DKA, admitted to Emory University Hospitals between 01/01/2006 to 12/31/2016. DKA and renal stages were confirmed on admission laboratory values.Admission bicarbonate levels (13.9±5 vs 13.4±5.3 vs 13.8±4.2 mmol/L, p=0.7), and pH levels (7.2±0.3 vs 7.2±0.2 vs 7.2±0.2, p=0.8) were similar among groups. Patients with ESKD had lower mean ß -hydroxybutyrate (4.3±3.3 vs 5.6±2.9 vs 5.9±2.5 mmol/L, p=0.01), but higher admission glucose (852±340.4 vs 714.6±253.3 mg/dL vs 518±185.7 mg/dL, p <0.01), anion gap (23.4±7.6 vs 23±6.9 vs 19.5±4.7 mmol/L, p <0.01), and osmolality (306±20.6 vs 303.5± vs 293.1±3.1mOsm/kg, p<0.01), compared to patients with moderate renal failure and preserved renal function. The sensitivity of ß-hydroxybutyrate >3 mmol/L for diagnosing DKA by bicarbonate level <15 and <18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels <10, 10-15, <18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively.Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level > 3 mmol/L may assist with confirmation of DKA diagnosis.

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Authors: Rodolfo J Galindo, Francisco J Pasquel, Priyathama Vellanki, Cesar Zambrano, Bonnie Albury, Citlalli Perez-Guzman, Ziduo Zheng, Guillermo E Umpierrez