ArticleEndocrine2026
Diabetic ketoacidosis in end-stage renal disease: propensity score-matched national inpatient outcomes.
Article in Endocrine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
backgroundDiabetic 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.
methodsWe 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.
resultsAfter 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.
conclusionsAmong 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.
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