Cardiorenal Metabolic Modifiers of In-Hospital Outcomes Among Hospitalizations with Acute Kidney Injury

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Acute kidney injury (AKI) is a frequent, high-risk hospitalization complication, particularly in patients with chronic cardiometabolic diseases.
• The combined impact of heart failure (HF) and diabetes mellitus (DM) on AKI outcomes is not fully understood.
• Understanding these interactions is crucial for managing hospitalized patients with AKI.

Purpose of the Study:

• To investigate the joint impact of HF and DM on in-hospital risk profiles and adverse outcomes in patients with AKI.
• To characterize distinct cardiorenal metabolic phenotypes and their association with AKI-related complications.
• To assess the cumulative burden of adverse events across different AKI patient subgroups.

Main Methods:

• Retrospective analysis of a nationally representative inpatient database for adult hospitalizations with AKI.
• Classification of hospitalizations into four phenotypes: AKI alone, AKI with HF, AKI with DM, and AKI with both HF and DM.
• Multivariable logistic regression models were used to analyze in-hospital mortality, dialysis initiation, and mechanical ventilation, considering HF, DM, and their interaction.

Main Results:

• AKI outcomes varied significantly by cardiorenal metabolic phenotype.
• Heart failure (HF) was linked to increased mortality and mechanical ventilation risk.
• A synergistic interaction between HF and DM elevated the risk of dialysis initiation, with the combined group showing the highest cumulative adverse event burden.

Conclusions:

• Cardiorenal metabolic status significantly modifies in-hospital outcomes for AKI patients.
• HF is a dominant risk modifier for AKI, while DM has specific effects and exacerbates dialysis risk when co-occurring with HF.
• Incorporating cardiometabolic context is vital for AKI risk stratification and multidimensional patient assessment.