Diabetic Kidney Alarm (DKA) Study – Tubulopathy in new onset diabetic ketoacidosis
BACKGROUND: Type 1 diabetes (T1D) presents most commonly in childhood and translates to a lifetime of exposure and risk for early death from cardiovascular disease (CVD) and diabetic kidney disease (DKD). Over 1.25 million American children and adults have T1D, and most youth diagnosed with T1D in the US present with DKA; the incidence of DKA in youth at diagnosis of T1D in Colorado between 1998-2012 increased by 55%, which is much higher than reported in Canada or United Kingdom.
GAP: DKA is characterized by dehydration, metabolic acidosis and hyperglycemia, all risk factors for tubular injury, but it is unknown whether DKA is sufficient to cause tubulopathy.
HYPOTHESIS: The overarching hypothesis of this study is that irreversible tubulopathy exists in new onset DKA and that it is related to urine uric acid (UUA)-mediated injury.
METHODS: This observational study will prospectively examine markers of renal health from diagnosis of DKA in the setting of new onset T1D through 3-months of follow-up. Boys and girls (age 3-21) with new onset T1D presenting with DKA to the Children’s Hospital Colorado (CHCO) ED.
IMPACT: If the results of the pilot study demonstrate evidence of irreversible tubulopathy in new onset DKA, the next step would be a clinical trial to evaluate strategies to protect the tubules in youth with new onset T1D with DKA. The study findings will also be relevant to the rising number of overweight and obese youth who are at risk of type 2 diabetes, a condition associated with even higher rates of DKD than in T1D.