Patients with diabetic ketoacidosis have unique diagnostic renal parameters that may suggest disease severity

b-hydroxybutyrate> 3 mmol / L in patients with end-stage renal disease may indicate diabetes ketoacidosis, according to the results of an observational study published in Journal of Clinical Endocrinology and Metabolism.

The study included 504 patients who were treated with hemodialysis at Emory University Hospital in Atlanta between 2006 and 2016.

Of the 504 patients included in the study, 49 had end-stage renal disease (mean age 50.5 years), 305 patients had moderate renal failure (mean age 51 years), and 150 had preserved renal function (mean age 35.6 years). ). Patients were 61%, 50%, and 48% women, respectively; and, 84%, 70% and 79% of blacks, respectively. Patients with end-stage renal disease had higher glucose (Str <.0001), potassiumStr <.001) and osmolarityStr <.001) and lower glycated hemoglobinStr = .01), sodiumStr = .001) and b-hydroxybutyrateStr = .01) concentrations relative to other patients.

b-hydroxybutyrate and bicarbonate were negatively correlated among all groups of patients (end – stage renal disease: r, -0.48; Str = .0005; moderate: r, -0.52; Str <.0001; preserved: r, -0.59; Str <.0001). The bicarbonate level <10 mmol / L corresponded to b-hydroxybutyrate of 5.5 (95% CI, -0.40 to 11.5), 6.5 (95% CI, 1.5-11.5) and 7, 2 (95% CI, 3.3-11.2) mmol / L and bicarbonate levels <18 mmol / L with 3.0-b-hydroxybutyrate (95% CI, -3.0 to 8.9), 4, 1 (95% CI, -0.9 to 9.1) and 4.4 (95% CI, 4.0-4.9) mmol / L among ESKD, moderate and preserved patient groups, respectively.

b-hydroxybutyrate> 3 mmol / L among patients with end-stage renal disease had a sensitivity of 86% (95% CI, 73% -100%) and a specificity of 69% (95% CI, 51% -86%) for bicarbonate detection < 15 mmol / L. Among patients with moderate or preserved renal function, the same cut-off data had a sensitivity of 89% (95% CI, 84% -93%) and 96% (95% CI, 91% -100%) and specificity 42% (95% CI, 34% -49%) and 33% (95% CI, 22% -44%).

The cut-off values ​​identified in this study require validation in an independent cohort to determine their usefulness in clinical practice.

These data suggest that b-hydroxybutyrate> 3 mmol / L may be a valuable diagnostic limit for patients with end-stage renal disease and diabetic ketoacidosis.

Publication: Several authors have stated that it is industry related. For a complete list of discoveries, see the original article.

Reference

Galindo RJ, Pasquel FJ, Vellanki P and others. Biochemical parameters of ketoacidosis diabetes in patients with end – stage renal disease and preserved renal function. J Clin Endocrinol Metab. 2021; dgab126. doi: 10.1210 / Clinem / dgab126.

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