Key result
Diabetes linked to ~4-fold higher AKI risk in patients hospitalized with acute decompensated heart failure.
Observational (n=100)
No
In patients hospitalized with acute decompensated heart failure, half develop acute kidney injury, with diabetes and elevated admission NT-proBNP serving as strong, easily obtainable predictors for cardiorenal risk stratification.
Background Cardiorenal syndrome type 1 (CRS-1), manifesting as acute kidney injury (AKI) during episodes of acute decompensated heart failure (ADHF), constitutes a clinically significant complication with independent adverse effects on both short- and long-term patient outcomes. Delineating the clinical, echocardiographic, and biochemical factors predisposing to this complication is foundational to risk-guided cardiorenal management. Prospective regional data from the Indian subcontinent addressing this clinical question remain insufficient. Materials and methods A prospective observational investigation enrolled 100 sequential adults who met the 2021 European Society of Cardiology (ESC) criteria for ADHF and were admitted to the Intensive Cardiac Care Unit and Medical ICU at Maharishi Markandeshwar University of Medical Sciences and Research (MMIMSR), Ambala, Haryana, India. AKI was ascertained using the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 serum creatinine thresholds after exclusion of competing aetiologies. Comorbid diagnoses, echocardiographic indices (Left Ventricular Ejection Fraction (LVEF), phenotypic classification), and admission biochemistry including serum sodium and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were prospectively documented. Associations between different variables and AKI were evaluated using Chi-square analysis, independent-samples t-test or Mann-Whitney U test, unadjusted odds ratios (OR) with 95% confidence intervals, and ROC curve analysis. A two-tailed p-value below 0.05 denoted statistical significance. Results Half the enrolled cohort (50%) fulfilled criteria for AKI. The Heart Failure with Preserved Ejection Fraction (HFrEF) phenotype (LVEF ≤40%) was present in 80.0% of AKI patients relative to 68.0% of AKI-free patients (OR 1.88; 95% CI 0.73-4.82; χ² = 1.87; p = 0.171). Among comorbid conditions, only diabetes mellitus attained statistical significance (OR 4.37; 95% CI 1.89-10.08; χ² = 11.95; p < 0.001). Biochemically, AKI patients exhibited substantially higher median NT-proBNP (16,832.5 vs 6,599.5 pg/mL; p < 0.001), and lower serum sodium (135.96 ± 4.38 vs 137.98 ± 4.03 mEq/L; p = 0.018). NT-proBNP yielded the greatest discriminatory capacity (AUC 0.74; 95% CI 0.64-0.83), ahead of serum sodium (area under the curve (AUC) 0.64) and LVEF (AUC 0.60). Conclusion AKI is encountered in half of patients hospitalised with ADHF at a North Indian tertiary centre. Diabetes mellitus represents the predominant metabolic risk determinant, while admission NT-proBNP furnishes the strongest single-biomarker discriminatory signal. These routinely obtainable parameters constitute a clinically actionable framework for cardiorenal risk stratification at hospital admission.
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Gupta et al. (2026) conducted an observational in Acute Decompensated Heart Failure (n=100). Diabetes mellitus vs. Absence of diabetes mellitus was evaluated on Acute kidney injury (AKI) (OR 4.37, 95% CI 1.89-10.08, p=<0.001). Diabetes mellitus was the predominant metabolic risk determinant for acute kidney injury (OR 4.37) in patients hospitalized with acute decompensated heart failure.
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