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Background <p>Diabetic ketoacidosis (DKA) increasingly occurs in patients with end-stage renal disease (ESRD), in whom standard management strategies may not be appropriate. Prior studies evaluating outcomes of DKA in ESRD are limited and yield inconsistent results. We compared in-hospital outcomes and healthcare utilization among patients hospitalized with DKA with and without ESRD using a national database.</p> Methods <p>We performed a retrospective cohort study using the National Inpatient Sample (2016–2022) of adult hospitalizations with a primary diagnosis of DKA, comparing patients with and without ESRD. Propensity score matching was used to balance demographics and comorbidities; multivariable regression was used to estimate adjusted odds ratios (aORs) for in-hospital mortality, major in-hospital complications, length of stay, and inflation-adjusted hospitalization costs.</p> Results <p>After propensity score matching, 78,470 hospitalizations were included (39,235 with ESRD and 39,235 without ESRD). In-hospital mortality was similar between patients with and without ESRD (0.9% vs. 1.0%; aOR 0.90, 95% CI 0.65–1.24; <i>p</i> = 0.524). However, ESRD was associated with significantly higher odds of vasopressor use (aOR 1.56), invasive mechanical ventilation (aOR 1.74), non-invasive ventilation (aOR 1.62), septic shock (aOR 1.71), seizures (aOR 1.67), and sudden cardiac arrest (aOR 1.65) (all <i>p</i> &lt; 0.05). ESRD was also associated with longer hospital length of stay (+ 1.42 days) and higher inflation-adjusted hospitalization costs (+$24,686) compared with matched non-ESRD patients.</p> Conclusions <p>Among patients hospitalized with DKA, ESRD was not associated with increased in-hospital mortality after adjustment but was linked to substantially greater morbidity and healthcare resource utilization. These findings highlight the need for ESRD-adapted DKA management strategies aimed at reducing complications rather than mortality alone.</p>

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Diabetic ketoacidosis in end-stage renal disease: propensity score–matched national inpatient outcomes

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Nida Anwaar,
  • Mohammed A. Quazi,
  • David A. Baron Herrera,
  • Humza Saeed,
  • Raja Ravender,
  • Eyad Mando-Dakkak,
  • Abu Baker Sheikh

摘要

Background

Diabetic ketoacidosis (DKA) increasingly occurs in patients with end-stage renal disease (ESRD), in whom standard management strategies may not be appropriate. Prior studies evaluating outcomes of DKA in ESRD are limited and yield inconsistent results. We compared in-hospital outcomes and healthcare utilization among patients hospitalized with DKA with and without ESRD using a national database.

Methods

We performed a retrospective cohort study using the National Inpatient Sample (2016–2022) of adult hospitalizations with a primary diagnosis of DKA, comparing patients with and without ESRD. Propensity score matching was used to balance demographics and comorbidities; multivariable regression was used to estimate adjusted odds ratios (aORs) for in-hospital mortality, major in-hospital complications, length of stay, and inflation-adjusted hospitalization costs.

Results

After propensity score matching, 78,470 hospitalizations were included (39,235 with ESRD and 39,235 without ESRD). In-hospital mortality was similar between patients with and without ESRD (0.9% vs. 1.0%; aOR 0.90, 95% CI 0.65–1.24; p = 0.524). However, ESRD was associated with significantly higher odds of vasopressor use (aOR 1.56), invasive mechanical ventilation (aOR 1.74), non-invasive ventilation (aOR 1.62), septic shock (aOR 1.71), seizures (aOR 1.67), and sudden cardiac arrest (aOR 1.65) (all p < 0.05). ESRD was also associated with longer hospital length of stay (+ 1.42 days) and higher inflation-adjusted hospitalization costs (+$24,686) compared with matched non-ESRD patients.

Conclusions

Among patients hospitalized with DKA, ESRD was not associated with increased in-hospital mortality after adjustment but was linked to substantially greater morbidity and healthcare resource utilization. These findings highlight the need for ESRD-adapted DKA management strategies aimed at reducing complications rather than mortality alone.