The mainstay of DKA management in patients with type 1 and type 2 diabetes includes the administration of intravenous fluids, insulin and electrolyte replacement therapy.11 For patients without cardiac or renal compromise, current guidelines recommend infusing isotonic saline at a rate of 15–20 mL/kg or 1–1.5 L during the first hour, with subsequent rate of 250–500 mL/hour.11 The higher rates of complications observed in our study suggest that treatment recommendations included in societies’ guidelines11 may not be applicable to patients with ESRD. This evidence concerns the gene INS and type 2 diabetes mellitus.