Management of diabetes-related hyperglycaemic emergencies in advanced chronic kidney disease: Review of the literature and recommendations.

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2024-07-11 DOI:10.1111/dme.15405

Dimitra Stathi, Ketan K Dhatariya, Omar G Mustafa

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引用次数: 0

Abstract

Aims: Despite the substantial progress in the management of diabetes mellitus (DM), chronic kidney disease (CKD) remains one of the most common complications. Although uncommon, diabetic emergencies [diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS)] can still occur in stage 4 and 5 CKD, at times with less typical clinical manifestations due to the altered pathophysiology, presence of chronic metabolic acidosis and effect of haemodialysis on glycaemic control and metabolic parameters. The purpose of this article is to review the current literature and provide recommendations for the diagnosis and treatment of DKA, euglycaemic DKA and HHS in people with advanced CKD.

Methods and results: Guidance on the management of diabetes-related emergencies mainly focuses on individuals with preserved renal function or early-stage CKD. Existing literature is limited, and recommendations are based on expert opinions and case reports. Given the clinical need for amended guidelines for this population, we are proposing a management algorithm for DKA and HHS based on clinical and metabolic parameters.

Conclusions: In this review article, we propose treatment algorithms for diabetes-related hyperglycaemic emergencies in people with advanced CKD. Further research is needed to validate our proposed algorithms.

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晚期慢性肾病患者与糖尿病相关的高血糖急症管理：文献综述与建议。

目的：尽管糖尿病（DM）的治疗取得了长足的进步，但慢性肾病（CKD）仍然是最常见的并发症之一。糖尿病急症[糖尿病酮症酸中毒 (DKA)、高渗性高血糖状态 (HHS)]虽然并不常见，但仍可能发生在 4 期和 5 期 CKD 中，由于病理生理学的改变、慢性代谢性酸中毒的存在以及血液透析对血糖控制和代谢参数的影响，有时临床表现并不典型。本文旨在回顾现有文献，并为晚期 CKD 患者的 DKA、优生 DKA 和 HHS 的诊断和治疗提供建议：糖尿病相关急症管理指南主要针对肾功能保留或早期 CKD 患者。现有文献资料有限，建议均基于专家意见和病例报告。鉴于临床需要对这一人群的指南进行修订，我们根据临床和代谢参数提出了 DKA 和 HHS 的管理算法：在这篇综述文章中，我们提出了晚期 CKD 患者糖尿病相关高血糖急症的治疗算法。我们还需要进一步的研究来验证我们提出的算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”