Predictors, Morbidity, and Healthcare Costs of Acute Kidney Injury in Diabetic Ketoacidosis: A Decade-Long Retrospective Cohort Study of 464,057 US Hospitalizations

Diabetic ketoacidosis (DKA) frequently results in acute kidney injury (AKI), elevating mortality and healthcare costs. However, comprehensive national studies on AKI risk factors in DKA patients are scarce. A retrospective analysis was conducted on 464,057 hospitalizations for DKA throughout the United States from 2010 to 2019, using the Nationwide Inpatient Sample database. Instances of AKI were identified through ICD-9/10 diagnostic codes, and multivariable logistic regression was applied to assess risk factors, including demographic characteristics, preexisting comorbidities, complications and institutional variables. In the analyzed cohort, 175,233 patients (37.8%) developed AKI, with its prevalence increasing from 28.2% in 2010 to 46.3% by 2019. The multivariate analysis indicated several independent risk factors: age ≥ 45 years; Black race; comorbidities ≥1; bed size of hospital (medium, large); urban and teaching hospitals; region of hospital (Midwest/North Central, South, West); preexisting comorbidities [congestive heart failure, coagulopathy, fluid and electrolyte disorders, other neurological disorders, pulmonary circulation disorders, chronic kidney disease (CKD) excluding end-stage renal disease (ESRD), weight loss, pancreatitis]. Protective factors included being female, Hispanic/Native American, having Medicaid, private insurance/self-pay, and undergoing elective admission. The development of AKI was associated with worsened outcomes, including increased complications, a greater need for invasive therapies (dialysis, ventilator support), prolonged hospital stays (median 4 vs. 3 days; P < 0.001), higher median treatment costs ($31,386 vs. $20,157; P < 0.001), and increased mortality rates (4.1% vs. 0.9%, P < 0.001). AKI is prevalent in DKA, linked to higher mortality and costs, necessitating early risk assessment and intervention.