Glycemic phenotype, age at diabetes diagnosis, and risk of cardiorenal syndrome type 1 in patients hospitalized with acute heart failure

Background In China, associations of glycemic phenotype and age at diabetes diagnosis with cardiorenal syndrome type 1 (CRS-1) in acute heart failure (AHF) remains underexplored. Methods We conducted a single-center cohort study of adults hospitalized for AHF (Peking University Third Hospital, 2017–2022). Glycemic phenotype was categorized using medical history, admission fasting blood glucose, and HbA1c. Age at diabetes diagnosis was grouped as <40, 40–49, 50–59, 60–69, and ≥ 70 years. CRS-1 was defined according to the KDIGO criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression with prespecified sequential adjustment; statistical mediation involving creatine kinase-MB (CK-MB) was explored. Results Among 1059 AHF patients, 248 developed CRS-1 (23.4%). Compared with no diabetes, CRS-1 odds were higher for the dysglycemic phenotype without prior diagnosis (OR 1.76, 95% CI 1.16–2.66) and higher glycemic burden (1.85, 1.25–2.75), but not for pre-diabetes or lower glycemic burden. Additional adjustment for CK-MB attenuated these associations to 1.41 (0.92–2.18) and 1.67 (1.12–2.49), respectively. Estimated mediated proportions were 35.6% ( P = 0.018) and 16.7% ( P = 0.002), respectively. Diabetes diagnosed before age 40 years was associated with higher CRS-1 odds (OR 2.38, 1.10–5.15), and the spline analysis suggested higher CRS-1 odds at younger ages at diagnosis. Conclusions In AHF, a dysglycemic phenotype without prior diagnosis and higher glycemic burden were associated with higher CRS-1 odds. These associations were attenuated after CK-MB adjustment. Earlier diabetes onset may also indicate higher CRS-1 risk, supporting closer glycemic and renal monitoring.