{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:00:32Z","timestamp":1777914032350,"version":"3.51.4"},"reference-count":22,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2021,2,28]],"date-time":"2021-02-28T00:00:00Z","timestamp":1614470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institute of Health","doi-asserted-by":"publisher","award":["P30DK111024"],"award-info":[{"award-number":["P30DK111024"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institute of Health","doi-asserted-by":"publisher","award":["1K23DK123384-01"],"award-info":[{"award-number":["1K23DK123384-01"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"Clinical and Translational Science Award program","doi-asserted-by":"publisher","award":["NIH\/NATS UL1 TR002378"],"award-info":[{"award-number":["NIH\/NATS UL1 TR002378"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"NIH and National Center for Research Resources","doi-asserted-by":"publisher","award":["1P30DK111024-01"],"award-info":[{"award-number":["1P30DK111024-01"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["1K23GM128221-01A1"],"award-info":[{"award-number":["1K23GM128221-01A1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["3K12HD085850-03S1"],"award-info":[{"award-number":["3K12HD085850-03S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and \u00df-hydroxybutyrate in patients with ESKD (eGFR &amp;lt; 15 mL\/min\/1.73 m2), moderate renal failure (eGFR 15\u201360), or preserved renal function (eGFR &amp;gt; 60).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This observational study included adults (18\u201380 years) with diabetes ketoacidosis (DKA), admitted to Emory University Hospitals between January 1, 2006 to December 31, 2016. DKA and renal stages were confirmed on admission laboratory values.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Admission bicarbonate levels (13.9 \u00b1 5 vs 13.4 \u00b1 5.3 vs 13.8 \u00b1 4.2 mmol\/L, P = 0.7), and pH levels (7.2 \u00b1 0.3 vs 7.2 \u00b1 0.2 vs 7.2 \u00b1 0.2, P = 0.8) were similar among groups. Patients with ESKD had lower mean \u00df-hydroxybutyrate level (4.3 \u00b1 3.3 vs 5.6 \u00b1 2.9 vs 5.9 \u00b1 2.5 mmol\/L, P = 0.01), but higher admission glucose (852 \u00b1 340.4 vs 714.6 \u00b1 253.3 mg\/dL vs 518 \u00b1 185.7 mg\/dL, P &amp;lt; 0.01), anion gap (23.4 \u00b1 7.6 vs 23 \u00b1 6.9 vs 19.5 \u00b1 4.7 mmol\/L, P &amp;lt; 0.01), and osmolality (306 \u00b1 20.6 vs 303.5 \u00b1 vs 293.1 \u00b1 3.1mOsm\/kg, P &amp;lt; 0.01) compared with patients with moderate renal failure and preserved renal function, respectively. The sensitivity of \u00df-hydroxybutyrate &amp;gt; 3 mmol\/L for diagnosing DKA by bicarbonate level &amp;lt; 15 and &amp;lt;18 mmol\/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure, and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding \u00df-hydroxybutyrate with bicarbonate levels &amp;lt; 10, 10\u201315, &amp;lt;18 mmol\/L were 5.5, 3.9, 3.0 mmol\/L, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a \u00df-hydroxybutyrate level &amp;gt; 3 mmol\/L may assist with confirmation of DKA diagnosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab126","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T09:21:33Z","timestamp":1614849693000},"page":"e2673-e2679","source":"Crossref","is-referenced-by-count":16,"title":["Biochemical Parameters of Diabetes Ketoacidosis in Patients with End-stage Kidney Disease and Preserved Renal Function"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-3225","authenticated-orcid":false,"given":"Rodolfo J","family":"Galindo","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco J","family":"Pasquel","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyathama","family":"Vellanki","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar","family":"Zambrano","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie","family":"Albury","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Citlalli","family":"Perez-Guzman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng","family":"Ziduo","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillermo E","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, 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