Key result
Managing DKA and HHS in dialysis patients demands individualized care while new strategies await validation.
Treatment for DKA and HHS in ESRD patients on dialysis must be individualized, with emerging strategies requiring further validation.
Individualized DKA/HHS management is warranted in dialysis patients; leaves open validation of extended dialysis strategies.
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.
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Aoun et al. (2026) studied this question. Treatment of diabetic ketoacidosis and hyperosmolar hyperglycemic state in dialysis patients must be individualized; new strategies like extended dialysis need further validation.
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