Diabetic ketoacidosis in people on maintenance haemodialysis: case reports and review of literature


  • Apexa Kuverji John Walls Renal Unit, University Hospitals of Leicester
  • Kath Higgins University Hospitals of Leicester
  • James O Burton John Walls Renal Unit, University Hospitals of Leicester
  • Andrew H Frankel Imperial College Healthcare NHS Trust
  • Chee Kay Cheung John Walls Renal Unit, University of Leicester




diabetic ketoacidosis, haemodialysis, end-stage kidney disease


The management of diabetes ketoacidosis (DKA) in people with normal renal function is well established. Although DKA is less common in people with end-stage kidney disease (ESKD), when it occurs, the management needs to be adapted to account for the different physiological state that these patients present with. This report presents two cases of DKA in people on maintenance haemodialysis for ESKD. Each case identifies learning points, when combined with a comprehensive literature review, generates key recommendations on the management of DKA in people on maintenance haemodialysis.

Author Biographies

Apexa Kuverji, John Walls Renal Unit, University Hospitals of Leicester

Specialist Registrar in Nephrology and General Internal Medicine

Kath Higgins, University Hospitals of Leicester

Lead Clinician for Inpatient Diabetes Care and Consultant in Diabetes Care, Honorary Senior Lecturer University of Leicester

James O Burton, John Walls Renal Unit, University Hospitals of Leicester

Professor of Renal Medicine, Honorary Consultant Nephrologist, University Hospitals of Leicester

Andrew H Frankel, Imperial College Healthcare NHS Trust

Consultant Physician and Nephrologist, Imperial College Heathcrae NHS Trust; Lead for "Diabetes care in Haemodialysis" working group.

Chee Kay Cheung, John Walls Renal Unit, University of Leicester

NIHR Academic Clinical Lecturer and Consultant Nephrologist, University of Leicester


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