Background: Studies have shown that there is increased risk of intrinsic acute kidney injury (AKI) in patients with Type 1 Diabetes (T1D) following an episode of diabetic ketoacidosis (DKA). An association between episodes of DKA and greater risk for future diabetic nephropathy has not previously been studied in children. This research project aims to investigate whether DKA, with its potential ability to induce lasting renal insult, incurs an increased risk of developing diabetic nephropathy.
Methods: IRB approval was obtained at two sites, the UC Davis Medical Center and Children’s Hospital of Philadelphia, for a retrospective study of all patients with a pediatric diagnosis of T1D who had ≥ 1 measure of microalbumin to creatinine ratio (MA:Cr) and had no history of non-diabetic renal disease. Data was collected on their history of DKA, all MA:Cr values, and diagnosis of microalbuminuria which served to reflect as our early marker of diabetic nephropathy. Secondary data on sex, pH of DKA episodes, age at T1D diagnosis, and average HbA1c were collected to adjust for confounding factors. The MA:Cr values will be compared across patients with and without history of DKA.
Results: Early preliminary results do show a significant association between a history of DKA and developing microalbuminuria (Table 1). However, secondary analysis involving multivariable models are needed to adjust for possible confounding variables including age, diabetes duration, and glycemic control (HbA1c).
Conclusions: The results do not yet support nor deny if there is an increased risk of microalbuminuria following DKA. Following full statistical analysis taking into consideration confounding factors, we will be able to provide further conclusions.
