Abstract: PO0771
In-Hospital Outcomes in Diabetic Ketoacidosis and Impaired Kidney Function
Session Information
- Diabetic Kidney Disease: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Gangu, Karthik, University of Missouri System, Columbia, Missouri, United States
- Bobba, Aniesh, University of Missouri System, Columbia, Missouri, United States
Background
Diabetes Mellitus is one of the most common causes of End-Stage Renal Disease (ESRD) in the United States. In this study, we used the National Inpatient Sample (NIS) database to compare the outcomes of Diabetic Ketoacidosis(DKA) admissions in Chronic Kidney Disease (CKD) and ESRD to DKA with normal creatinine.
Methods
We performed a retrospective study by utilizing the 2016 NIS, which comprises 20% of hospital discharges for that year. We included patients aged 18 or older admitted to the hospital with a principal diagnosis of DKA. Diagnosis data were obtained by utilizing ICD 10 CM codes. A multivariate logistic regression model was used to analyze the effect of ESRD on mortality and intubation rate. Linear regression was used to analyze the impact of ESRD on length of stay. All outcomes were adjusted to age, sex, race, insurance status, Elixhauser Comorbidity index, hospital location, and characteristics.
Results
A total of 184,050 patients were included in the study, of which 12,605 had CKD and 6025 had ESRD. The mean age was 44.1 years (SD 12.8), and 51.9 % of patients were female in ESRD. The mean length of stay was 5.2 days for the ESRD group and 3.1 for DKA with the normal creatinine group. The adjusted length of stay was 0.9 day longer (p<0.001), and the adjusted cost of hospitalization was 13,684 US dollars more expensive in the ESRD group. Adjusted Odds Ratio for mortality 1.2 (CI 0.58-2.4, p = 0.61), and intubation 0.95 (CI 0.64-1.4, p = 0.81) were not statistically significant. Outcomes for CKD patients were similar to patients with normal creatinine. (Table 1)
Conclusion
DKA in ESRD patients was associated with increased length of stay and cost of hospitalization. Further studies looking into factors contributing to the longer length of stay in the ESRD population will help in improving outcomes and significant cost reduction in taking care of these patients.
Table 1
| Outcomes | DKA with normal creatinine(n=165960) | Stage 1 CKD(n=320) | Stage 2 CKD(n=1460) | Stage 3 CKD(n=7790) | Stage 4 CKD(n=2055) | Stage 5 CKD(n=440) | ESRD(n=6025) |
| In-hospital mortality(%) | 647(0.39%) | 5(1.5%) | 0 | 78(0.96%) | 15(0.73%) | 0 | 50(0.83%) |
| OR*(CI) | 1.9(0.26-13.8,p=0.52) | 0.73(0.4-1.3,p=0.31) | 0.68(0.21-2.21,p=0.53) | 1.2(0.58-2.4,p=0.61) | |||
| Intubation % | 1.3% | 1.5% | 1.03% | 3.2% | 3.1% | 4.5% | 3% |
| OR*(CI) | 0.44(0.05-3.2, p=0.43) | 0.28(0.09-0.89, p=0.03) | 0.72(0.51-1.03, p=0.73) | 0.68(0.36-1.28, p=0.24) | 1.42(0.5-4, p=0.5) | 0.95(0.64-1.4, p=0.81) | |
| Mean Los* | 3.1 | 4.3 | 4.1 | 4.9 | 5.1 | 5 | 5.2 |
| Adjusted Los* | 0.15(p=0.75) | -0.3(p=0.25) | 0.24(p=0.29) | 0.4(p=0.12) | 0.59(p=0.1) | 0.9(p<0.001) | |
| Mean $* | 28761 | 40084 | 35567 | 41603 | 42073 | 462068 | 52735 |
*Adjusted for Age, sex, race, elixhauser comorbidity index, insurance status hospital location and characteristics.