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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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Intravenous Fluid Bolus Volume and Resolution of Acute Kidney Injury in Children With Diabetic Ketoacidosis

Kelly R Bergmann1, Morgan Boes2, Heidi Vander Velden1

  • 1From the Department of Emergency Medicine, Children's Minnesota.

Pediatric Emergency Care
|January 31, 2023
PubMed

Insights

Intravenous fluid bolus volume did not impact acute kidney injury (AKI) in children with diabetic ketoacidosis (DKA). High fluid volumes did not significantly speed up AKI resolution in this pediatric DKA cohort.

Area of Science:

  • Pediatric Nephrology
  • Endocrinology
  • Critical Care Medicine

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children.
  • Acute kidney injury (AKI) is a common comorbidity in pediatric DKA.
  • The role of intravenous (IV) fluid bolus volume in AKI management in DKA is not well-defined.

Purpose of the Study:

  • To investigate the association between IV fluid bolus volume and creatinine trends in children with DKA.
  • To determine if low versus high IV fluid bolus volumes affect the incidence or resolution of AKI in pediatric DKA.
  • To analyze the impact of fluid management on AKI recovery in children with DKA.

Main Methods:

  • Retrospective cohort study of children (≤21 years) with DKA from January 2012 to March 2020.
  • AKI defined by KDIGO creatinine criteria; fluid bolus categorized as low (<15 mL/kg) or high (≥15 mL/kg).
  • Statistical analysis included generalized additive mixed models for creatinine trends and Cox proportional hazard models for AKI resolution.

Main Results:

  • 23.9% of 708 DKA encounters had AKI at presentation; 1.4% developed AKI post-hospitalization.
  • No significant difference in AKI presentation or creatinine ratio trends between low and high fluid bolus groups.
  • High IV fluid bolus volume showed a non-significant trend towards faster AKI resolution (HR 1.062).

Conclusions:

  • IV fluid bolus volume is not significantly associated with the resolution of AKI in children with DKA.
  • Current fluid management strategies may not substantially alter AKI outcomes in this population.
  • Further research may be needed to optimize fluid therapy for AKI in pediatric DKA.
Abstract

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