ArticleClinics (Sao Paulo, Brazil)2026
Acute kidney injury in children and adolescents with diabetic ketoacidosis managed with aggressive initial volume resuscitation.
Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo analyse AKI severity/resolution and laboratory aspects of paediatric patients with DKA managed with 0.9 sodium chloride boluses in larger initial volumes than recommended by current international guidelines.
methodsRetrospective cohort study conducted at the Emergency Department (ED) of a tertiary paediatric hospital in Brazil. Medical records of children and adolescents with DKA were reviewed from January 2008 to December 2017. Severity of AKI was assessed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Laboratory data for 72-hours and time to DKA and AKI resolution were analysed. Linear regression models and survival analysis of time to DKA and AKI resolution were performed.
resultsSixty-eight DKA episodes were included, and 61 had a kidney function assessment. The AKI prevalence was 76%: 48% stage-1, 28% stage-2. No patients developed stage-3 AKI. Patients received an average of 35± (16.0) mL/kg 0.9% sodium chloride bolus in the first 2 h of treatment and 54± (21.7) mL/kg in the first 4-hours. The mean time to AKI resolution was 10.4 (±15.0) hours: stage-1 AKI resolution was 8.1 (±9.0) hours, and stage-2 resolution was 24.9 (±20.1) hours (p = 0.001). Forty-three percent of severe DKA episodes were associated with stage-1 AKI and 52% with stage-2 (p = 0.002). Serum chloride levels were not associated with time for AKI or DKA resolution.
conclusionIn this single-centre cohort, an aggressive initial fluid protocol was associated with rapid AKI resolution without severe hyperchloraemia. However, due to the lack of a control group and potential confounding by indication, these findings require validation in prospective, controlled studies.
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