BACKGROUND Emerging evidence has demonstrated that acute kidney injury (AKI) is an important risk factor associated with increased morbidity and mortality in diabetic ketoacidosis (DKA) patients. The current study aimed to investigate the incidence rate, risk factors, long-term renal outcomes, and mortality in DKA patients with AKI. METHODS A total of 179 patients diagnosed with DKA at Sun Yat-sen Memorial Hospital from January 2012 to January 2018 were included in the analysis. AKI was diagnosed according to the 2012 KDIGO criteria. Risk factors, long-term renal outcomes, and mortality were analyzed by logistic regression and Cox proportional hazards models. RESULTS Among 179 DKA patients, 98 patients (54.75%) were diagnosed as AKI. Aging; increased blood glucose, serum uric acid and white blood cells; decreased serum pH and albumin; coma; and preexisting chronic kidney disease (CKD) were risk factors of AKI in patients with DKA. During follow-up, DKA patients with AKI showed more than a two-fold decline in eGFR within 1 year after discharge from the hospital when compared with non-AKI DKA patients. Furthermore, AKI was also an independent risk factor for poor long-term renal outcomes and mortality in DKA patients. CONCLUSIONS Multiple risk factors contribute to the development of AKI in DKA patients. AKI and advanced AKI stage are associated with rapid progressive CKD and long-term mortality in patients with DKA.

中文翻译：

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住院的糖尿病酮症酸中毒患者的急性肾脏损伤的发生率，危险因素和长期结果。

背景技术新兴证据表明，急性肾损伤（AKI）是与糖尿病酮症酸中毒（DKA）患者发病率和死亡率增加相关的重要危险因素。当前的研究旨在调查DKA AKI患者的发生率，危险因素，长期肾脏结局和死亡率。方法对2012年1月至2018年1月在中山纪念医院诊断为DKA的179例患者进行分析。根据2012年KDIGO标准诊断出AKI。通过逻辑回归和Cox比例风险模型分析危险因素，长期肾脏结局和死亡率。结果179例DKA患者中，有98例（54.75％）被诊断为AKI。老化; 血糖，血清尿酸和白细胞增加；降低血清pH和白蛋白；昏迷; 和先前存在的慢性肾脏疾病（CKD）是DKA患者AKI的危险因素。在随访期间，与非AKI DKA患者相比，出院后1年内DKA AKI患者的eGFR下降了两倍以上。此外，AKI还是DKA患者长期肾结局不良和死亡率低的独立危险因素。结论多种危险因素有助于DKA患者AKI的发展。AKA和AKI晚期与DKA患者的快速进行性CKD和长期死亡率相关。在DKA患者中，AKI还是长期肾预后不良和死亡率低的独立危险因素。结论多种危险因素有助于DKA患者AKI的发展。AKA和AKI晚期与DKA患者的快速进行性CKD和长期死亡率相关。在DKA患者中，AKI还是长期肾预后不良和死亡率低的独立危险因素。结论多种危险因素有助于DKA患者AKI的发展。AKA和AKI晚期与DKA患者的快速进行性CKD和长期死亡率相关。