Abstract
Objective: To identify risk factors associated with acute kidney injury (AKI) in pediatric patients presenting with diabetic ketoacidosis (DKA).
Methodology: This prospective cohort study was conducted from August 2024 to June 2025 at two tertiary pediatric hospitals. A total of 112 children and adolescents (<18 years) admitted with DKA were included. Patients with pre-existing chronic kidney disease, congenital renal anomalies, or incomplete data were excluded. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine levels. Demographic, clinical, and laboratory parameters (including arterial pH, blood urea, serum creatinine, and diabetes status) were recorded at admission. Multivariate logistic regression analysis was performed to determine independent factors associated with AKI.
Results: AKI developed in 31 of 112 patients (27.7%). Most were classified as Stage I (71.0%), followed by Stage II (25.8%) and Stage III (3.2%). Multivariate analysis showed that AKI was independently associated with increasing severity of acidosis (adjusted odds ratio [AOR] per 0.1 decrease in pH: 2.770; 95% CI: 1.556–4.931; p=0.001), higher blood urea levels at admission (AOR per 1 mg/dL increase: 1.091; 95% CI: 1.032–1.155; p=0.002), and newly diagnosed diabetes (AOR: 4.199; 95% CI: 1.272–13.867; p=0.019).
Conclusion: AKI is a common complication of pediatric DKA and is independently associated with severe acidosis, elevated blood urea, and newly diagnosed diabetes. Early recognition of these risk factors may allow timely intervention and improved clinical outcomes.

Key words: Acute kidney injury, diabetic ketoacidosis, pediatric, risk factors.