Diabetic ketoacidosis and hyperosmolar hyperglycemic state in patients with end-stage renal disease on dialysis: a review.

PURPOSE: This review aims to discuss the prevalence, risk factors, and management of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in patients with end-stage renal disease (ESRD) on hemodialysis.

METHODS

A comprehensive literature review of retrospective studies, case reports, and clinical guidelines was conducted.

RESULTS

DKA and HHS incidence is lower in ESRD patients due to delayed insulin clearance and regular dialysis. Management requires cautious fluid administration, reduced insulin infusion rates, conservative potassium replacement, and gradual correction of hyperosmolarity. Emergency hemodialysis may be necessary for severe acidosis or hyperkalemia.

CONCLUSION

Treatment must be individualized. Emerging strategies, including extended dialysis sessions and closed-loop insulin delivery, require further validation.