Abstract
Acute kidney injury (AKI) in hospitalized patients is increasingly recognized as part of a broader cardiorenal metabolic process rather than an isolated renal event. Heart failure (HF) and diabetes mellitus (DM) frequently coexist among patients at risk for AKI and contribute to hemodynamic, neurohormonal, and metabolic disturbances that influence clinical outcomes. However, current risk stratification approaches often evaluate these conditions independently, potentially overlooking their interactive effects.
Emerging evidence suggests that HF and DM define distinct patterns of risk among patients with AKI. HF consistently identifies a subgroup with greater illness severity, including higher risks of mortality and need for advanced supportive care. Mechanistically, reduced cardiac output, venous congestion, and neurohormonal activation contribute to renal vulnerability and impaired recovery. In contrast, DM demonstrates more heterogeneous associations. Although some observational studies have reported lower short-term mortality among patients with DM, this finding should not be interpreted as evidence of a protective effect, given the persistent susceptibility to clinically significant renal injury. Notably, the coexistence of HF and DM is associated is associated with a disproportionate increase in dialysis initiation, suggesting synergistic cardiorenal vulnerability. Collectively, these findings support a more integrated approach to risk assessment and reinforce the importance of multidisciplinary cardiorenal care in high-risk patients.
Keywords
Acute kidney injury, Cardiorenal syndrome, Heart failure, Diabetes mellitus, Risk stratification, Dialysis initiation, Cardiorenal metabolic phenotype