Chronic Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes.

Abstract

Sodium-glucose cotransporter inhibitors (SGLTi) in type 1 diabetes increase diabetic ketoacidosis (DKA) risk but may offer kidney protection. This study assesses whether a reduced estimated glomerular filtration rate (eGFR) increases DKA risk even without SGLTi. Time-varying eGFR and hazard of first DKA event were analyzed from 35-year data in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study using Poisson and extended Cox proportional hazards models. Of 1,441 participants, 297 experienced 488 DKA events. Unadjusted and adjusted DKA rates in individuals with eGFR between 30 and 90 mL/min/1.73 m2 showed no statistical difference compared with those with eGFR 90-120 mL/min/1.73 m2 (incidence rate of 0.65 events per 100 person-years). A reduced eGFR (between 30 and 90 mL/min/1.73 m2) alone was not associated with increased DKA risk. This finding supports further research into potential kidney-protection benefits of SGLTi for selected individuals with type 1 diabetes.