Relationship between Arterial and Venous Biochemistry and Acid-Base Values in Patients with Diabetic Ketoacidosis and Chronic Kidney Disease
| dc.contributor.author | Gatua, Wilfred Kimani | |
| dc.date.accessioned | 2024-09-30T11:03:37Z | |
| dc.date.available | 2024-09-30T11:03:37Z | |
| dc.date.issued | 2024-06 | |
| dc.description | A Thesis Submitted in Fulfilment of the Requirements for the Award of the Degree of Doctor of Philosophy (Medical Biochemistry) in the School of Pure and Applied Sciences, Kenyatta University June 2024 Supervisors: 1. Joseph J.N. Ngeranwa 2. Joseph Makumi (Posthumous) 3. Eliud N.M. Njagi | |
| dc.description.abstract | Two of the complications of diabetes mellitus include diabetic ketoacidosis (DKA) and chronic kidney disease (CKD) and both conditions may lead to metabolic acidosis. In DKA there is excessive oxidation of fatty acids with subsequent accumulation of acetoacetate and β-hydroxybutyric acid while in patients with kidney dysfunction, the renal tubules lose the ability to regenerate bicarbonates effectively with resultant reduction of bicarbonate in blood. Clinical management of metabolic acidosis requires frequent arterial blood gas analysis (BGA) to determine the levels of acid-base parameters. Other biochemistry parameters tested to monitor the progress of management include: liver function tests, kidney function tests and pancreatic function tests. Arterial puncture is a painful and traumatic procedure which may lead to the formation of hematomas and sepsis and requires special skills to perform. There is therefore the need to substitute arterial blood with venous blood which is easy to obtain and is less painful to patients and has less complications. However, venous blood as a substitute for arterial blood has not been evaluated in the country to ascertain the level of relationship and agreement with arterial blood. The objective of this study was to evaluate levels of acid-base and routine biochemistry parameters in both arterial and venous blood in patients with diabetic ketoacidosis and chronic kidney disease and also determine the relationship and agreement between the two types of blood samples. A cross-sectional study composed of 200 patients with CKD and 150 patients sampled at Kenyatta National Hospital were uesd. Arterial and venous blood were collected from each study subject, and acid-base parameters, liver, kidney, and pancreatic function tests were carried out. Laboratory methods included measurements of acid-base parameters using RapidLab 348 blood gas analyzer. Biolis Clinical Chemistry Autoanalyser was used for the measurements of biochemistry parameters. The data generated was tested for its normality using Kolmogorov-Smirnov test. The results were expressed as mean ± SD and t-test used for statistical comparison of two means for two data sets. For relationships between measured arterial and venous blood parameters, correlation coefficient, simple and multiple linear regressions was used. For agreement between measured arterial and venous blood parameters, Bland-Altman bias plot was used. The key findings of this study were that patients with DKA and CKD have significant variations in the levels of both acid-base and biochemistry parameters. The generated bootstrapped simple linear regression equations between the measured arterial and venous blood analytes demonstrated strong correlations and agreements. This study therefore validates the use of venous blood for the measurement of blood gas and biochemistry parameters in the management and monitoring of acid-base metabolic disorders in patients with chronic kidney disease and diabetic ketoacidosis. This will hopefully minimize the need for arterial sampling which is hazardous and traumatic to the patients. | |
| dc.description.sponsorship | Kenyatta University | |
| dc.identifier.uri | https://ir-library.ku.ac.ke/handle/123456789/28987 | |
| dc.language.iso | en | |
| dc.publisher | Kenyatta University | |
| dc.title | Relationship between Arterial and Venous Biochemistry and Acid-Base Values in Patients with Diabetic Ketoacidosis and Chronic Kidney Disease | |
| dc.type | Thesis |