Patients With Diabetic Ketoacidosis Have Unique Diagnostic Renal Parameters That May Suggest Disease Severity

Diagnosis Diabetic Ketoacidosis dka and syringe.
The differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease is not known, so in this featured study, researchers assess the relationship between these parameters finding significant metabolic differences.

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

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

Of the 504 patients enrolled in the study, 49 had end-stage kidney disease (mean age 50.5) 305 patients were in moderate renal failure (mean age 51 years) and 150 had preserved renal function (mean age 35.6). Patients were 61%, 50%, and 48% were women, respectively; and, 84%, 70%, and 79% Black, respectively. Patients with end-stage kidney disease had higher glucose (P <.0001), potassium (P <.001), and osmolarity (P <.001) and lower glycated hemoglobin (P =.01), sodium (P =.001), and b-hydroxybutyrate (P =.01) concentrations compared with other patients.

b-hydroxybutyrate and bicarbonate was negatively correlated among all patient groups (end-stage kidney disease: r, -0.48; P =.0005; moderate: r, -0.52; P <.0001; preserved: r, -0.59; P <.0001). Bicarbonate levels of <10 mmol/L corresponded with 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 b-hydroxybutyrate of 3.0 (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 the ESKD, moderate, and preserved patient groups, respectively.

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

The cut-off values identified in this study require confirmation in an independent cohort in order to determine their utility in clinical practice.

These data indicated b-hydroxybutyrate >3 mmol/L may be a valuable diagnostic cut-off for patients with end-stage kidney disease and diabetic ketoacidosis.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Galindo R J, Pasquel F J, Vellanki P, et al. Biochemical Parameters of Diabetes Ketoacidosis in patients with End-Stage Kidney Disease and Preserved Renal Function. J Clin Endocrinol Metab. 2021;dgab126. doi:10.1210/clinem/dgab126.