Hyperkalemia During Diabetic Ketoacidosis and the Association With Acute Kidney Injury

OBJECTIVES To determine the association between hyperkalemia and acute kidney injury (AKI) during diabetic ketoacidosis (DKA) and to identify factors associated with hyperkalemia during DKA. METHODS We conducted an observational retrospective cohort study among patients presenting to a pediatric emergency department with a diagnosis of DKA between January 1, 2012, and September 30, 2023. Hyperkalemia was defined as the first nonhemolyzed serum potassium of at least 5.5 mEq/L. AKI was defined by the Kidney Disease Improving Global Outcomes creatinine criteria. Descriptive statistics and binary logistic regression were used to compare outcomes. Multivariate linear regression was used to estimate the association between resolution of hyperkalemia and AKI status. RESULTS We identified 1359 encounters, of which 115 (8.5%) had hyperkalemia and 252 (18.5%) had AKI. The proportion of encounters with AKI was significantly higher among those with hyperkalemia (n = 55; 47.8%) compared with those without (n =  197; 15.8%) (P < .001). AKI was associated with hyperkalemia (adjusted odds ratio [aOR], 1.79; 95% CI, 1.07–3.10). Moderate (aOR, 4.26; 95% CI, 2.32–7.82) and severe (aOR, 4.46; 95% CI, 2.37–8.42) compared with mild acidosis was associated with greater odds of hyperkalemia. The presence of AKI was not associated with time to first normal potassium (standardized β coefficient, −0.01; 95% CI, −77.48 to 68.12; P value = .899). CONCLUSIONS This study demonstrated associations between DKA-related AKI, acidosis severity, and hyperkalemia. Resolution of hyperkalemia occurred at a similar rate regardless of AKI status. Our findings may have implications for acute diabetes care.