{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:51:44Z","timestamp":1780613504912,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Guidance on the management of diabetes\u2010related emergencies mainly focuses on individuals with preserved renal function or early\u2010stage 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this review article, we propose treatment algorithms for diabetes\u2010related hyperglycaemic emergencies in people with advanced CKD. Further research is needed to validate our proposed algorithms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.15405","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T09:43:47Z","timestamp":1720691027000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of diabetes\u2010related hyperglycaemic emergencies in advanced chronic kidney disease: Review of the literature and recommendations"],"prefix":"10.1111","volume":"42","author":[{"given":"Dimitra","family":"Stathi","sequence":"first","affiliation":[{"name":"Department of Diabetes King's College Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3619-9579","authenticated-orcid":false,"given":"Ketan K.","family":"Dhatariya","sequence":"additional","affiliation":[{"name":"Elsie Bertram Diabetes Centre Norfolk and Norwich University Hospitals NHS Foundation Trust  Norwich UK"},{"name":"Norwich Medical School University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar G.","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Department of Diabetes King's College Hospital NHS Foundation Trust  London UK"},{"name":"King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2017.10.011"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.14.1782"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2021.16"},{"issue":"5","key":"e_1_2_7_5_1","article-title":"Outcomes of diabetic ketoacidosis in adults with end\u2010stage kidney disease: retrospective study based on a national database","volume":"14","author":"Gangu K","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2015.12.007"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-0165-1"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-024-06183-8"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/diab.29.11.926"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.5049\/EBP.2021.19.2.29"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14788"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v12.i5.514"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2019.06.022"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab126"},{"issue":"7","key":"e_1_2_7_15_1","article-title":"Management of diabetic ketoacidosis in a patient with chronic kidney disease under maintenance hemodialysis: a case report","volume":"15","author":"Regmi M","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976-9668.198348"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-017-1251-6"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-2176"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13676"},{"issue":"2","key":"e_1_2_7_20_1","first-page":"S43","article-title":"Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis","volume":"12","author":"Gupta A","year":"2008","journal-title":"Hemodial Int"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-000763"},{"issue":"4","key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Kidney Disease: Improving Global Outcomes CKDWG","year":"2024","journal-title":"Kidney Int"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-1-23"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12756"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v14.i8.1314"},{"issue":"9","key":"e_1_2_7_26_1","article-title":"A literature review of the therapeutic perspectives of sodium\u2010glucose Cotransporter\u20102 (SGLT2) inhibitor\u2010induced euglycemic diabetic ketoacidosis","volume":"14","author":"Patel K","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.10.014"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5118-8"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.1.131"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-197605000-00001"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15005"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.10.008"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac270"},{"key":"e_1_2_7_34_1","unstructured":"Excellence.NIfHaC. Intravenous fluid therapy in over 16s in hospital [article online]2013."}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.15405","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T08:53:37Z","timestamp":1736931217000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.15405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,11]]},"references-count":33,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1111\/dme.15405"],"URL":"https:\/\/doi.org\/10.1111\/dme.15405","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,11]]},"assertion":[{"value":"2024-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15405"}}