Hemodialysis for severe diabetic ketoacidosis-related acidosis without AKI or ESKD: incidence and outcomes in a single-center study
INTERNATIONAL JOURNAL OF DIABETES IN DEVELOPING COUNTRIES, cilt.46, sa.4, ss.1-9, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 46 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s13410-026-01751-7
- Dergi Adı: INTERNATIONAL JOURNAL OF DIABETES IN DEVELOPING COUNTRIES
- Derginin Tarandığı İndeksler: Academic Search Ultimate (EBSCO), Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Health Research Premium Collection (ProQuest), Scopus, Pharma Collection (ProQuest), Science Citation Index Expanded (SCI-EXPANDED), CINAHL, EMBASE
- Sayfa Sayıları: ss.1-9
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Background Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Although renal replacement therapy is occasionally required in DKA, dialysis is typically initiated because of the underlying chronic kidney disease (CKD) or acute kidney injury (AKI). Evidence describing hemodialysis for persistent severe DKA-related acidosis in the absence of acute kidney injury (AKI) or end-stage kidney disease (ESKD) remains scarce. Objective We aimed to investigate the incidence and clinical characteristics of patients requiring hemodialysis for persistent severe DKA-related acidosis without AKI or ESKD. Methods We conducted a retrospective single-center cohort study of adult patients admitted to the intensive care unit (ICU) with DKA between January 2021 and December 2024. The primary outcome was the requirement for HD during ICU stay. Results A total of 266 patients were included (53% T1DM, 47% T2DM; mean age 43.4 ± 20.6 years; 53% female). The overall in-hospital mortality was 9.4%. Ten patients (3.8%) required HD, of whom three (1.1%) underwent hemodialysis for persistent severe DKA-related acidosis without AKI or ESKD. These three patients (two T1DM and one T2DM with CKD but no AKI) all presented with severe acidosis despite optimized conventional therapy and were successfully treated with 2–4 HD sessions. Conclusions Hemodialysis for persistent severe DKA-related acidosis without AKI or ESKD was rare (1.1%), but clinically significant, representing a subset of patients with profound, treatment-refractory acidosis. Recognition of this phenotype may guide the timely initiation of dialysis in selected cases.