Abstract
Disclosure: S. Iftikhar: None. T. Jain: None. K. Zulqadar: None. A. Farid: None. N. Jaafar: None. R. Horowitz: None.
Double Jeopardy: Worse Outcomes and Higher Costs in DKA Patients with CKDIntroduction: Diabetic Ketoacidosis (DKA) is a serious but preventable complication that is associatedwith significant morbidity and mortality. Management depends on aggressive fluidresuscitation, insulin therapy, and electrolyte monitoring. However, available protocols areprimarily geared towards patients with normal kidney function. In this study, we aim toassess the effect of Chronic Kidney Disease (CKD)/End-Stage Renal Disease (ESRD) on theclinical outcomes and healthcare utilization in patients with DKA. Methods: We queried the 2021 National Inpatient Sample (NIS) for adult DKA hospitalizations andcompared patients based on the presence of CKD/ESRD, defined as CKD stages IV/V orESRD. The primary outcome was inpatient mortality and secondary outcomes includedcardiac arrest, intubation rates, length of stay (LOS), and total hospital charges. Univariateand multivariate logistic and linear regressions were used for statistical analyses . Weadjusted for age, gender, race, and primary insurance payer. Results: Nationwide, there were 354,195 DKA admissions in 2021, of which, 23,390 (6.60%) hadconcomitant CKD/ESRD. Patients with CKD/ESRD were older, more likely to be females orblack, and displayed an elevated Elixhauser comorbidity index. This index categorizespatient comorbidities using International Classification of Diseases (ICD) codes to predictin-hospital mortality and 30-day readmission risk. Patients with CKD/ESRD had higherrates of inpatient mortality, 9.90% vs. 8.80% with an adjusted odds ratio (aOR) of 1.53 (CI1.37–1.71, p < 0.001). They also demonstrated higher rates of cardiac arrest, 5.52% vs.2.49%, aOR 1.92 (CI 1.67–2.21, p < 0.001) and intubation, 13.53% vs. 7.79%, aOR 1.59 (CI1.44–1.75, p < 0.001). Additionally, patients with CKD/ESRD had longer LOS 9.58 vs. 5.63days with an adjusted mean difference (AMD) of 3.36 days (CI 2.98–3.74, p < 0.001) andhigher total hospital charges $139,931.20 vs. $77,302.25, AMD $55,149.80 (CI $47,055.90–$63,243.70, p < 0.001). Conclusion: While prospective trials are needed to determine the optimal management of patients withCKD/ESRD and DKA, our study suggests that patients with CKD/ESRD are at a higher risk ofworse clinical outcomes and higher healthcare utilization. Future research should explorepotential contributors to these disparities, such as higher rates of hypoglycemia, infection,or other metabolic derangements in ESRD patients, to identify modifiable factors that mayimprove outcomes. This study underscores the need for early identification and morepersonalized care to improve outcomes.
Presentation: Saturday, July 12, 2025