Impact of diabetes mellitus on short-term prognosis, length of stay, and costs in patients with acute kidney injury: A nationwide survey in China

Abstract

Background International data suggest that people with diabetes mellitus (DM) are at increased risk for worse acute kidney injury (AKI) outcomes; however, the data in China are limited. Therefore, this study aimed to describe the association of DM with short-term prognosis, length of stay, and expenditure in patients with AKI. Methods This study was based on the 2013 nationwide survey in China. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) and expanded criteria of AKI, 7604 patients with AKI were identified, and 1404 and 6200 patients were with and without DM, respectively. Clinical characteristics, outcomes, length of stay, and costs of these patients were compared. Multivariate regression analyses were conducted to evaluate the association of DM with mortality, failed renal recovery, length of stay, and costs. Results Patients with AKI and DM were older, had higher male preponderance (61.9%), presented with more comorbidities, and had higher serum creatinine levels compared with those without DM. An apparent increase in all-cause in-hospital mortality, length of stay, and costs was found in patients with DM. DM was not independently associated with failed renal recovery (adjusted OR (95%CI): 1.08 (0.94–1.25)) and in-hospital mortality (adjusted OR (95%): 1.16 (0.95–1.41)) in multivariate models. However, the diabetic status was positively associated with the length of stay (β = 0.06, p<0.05) and hospital expenditure (β = 0.10, p<0.01) in hospital after adjusting for possible confounders. Conclusion In hospitalized AKI patients, DM (vs. no DM) is independently associated with longer length of stay and greater costs, but is not associated with an increased risk for failed renal recovery and in-hospital mortality.

Impact of electronic AKI alert/care bundle on AKI inpatient outcomes: a retrospective single-center cohort study

“…For example, although the finding that a history of NSAID use and thiazide diuretics were each associated with lower odds of mortality in the univariable mode was unexpected given their associations with AKI [ 24 , 25 ], this association was not apparent in the multivariable model. Similarly, the crude statistically significant association between diabetes and all-cause inpatient mortality was not seen in the multivariable model, which is in keeping with conflicting data in the literature on this association [ 26 , 27 ]. By contrast, advancing CKD stage was associated with reduced all-cause inpatient mortality in the multivariable but not in the univariable model in our study, which is similar to a retrospective study of 82,711 hospitalized AKI events from the United States Department of Veterans Affairs healthcare system by Lafrance and Miller.…”

Risk Factors and Prognosis of Acute Kidney Injury after Cardiac Surgery in Patients with Chronic Kidney Disease

“…Some studies have shown that diabetes is an important risk factor for CSA-AKI [4,18,19], but there are few studies on the effect of diabetes on the adverse prognosis of CSA-AKI. Tan's study pointed out that diabetes was not associated with the failure of renal function recovery after AKI [20], but this study only included patients with AKI caused by various etiologies, and the conclusion was insufficient guidance for AKI caused by special etiology. Our results indicated that preoperative diabetes is an independent factor resulting in poor renal function recovery in patients with CKD after CSA-AKI.…”

Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts

“…In China, a country with a large DM patient population, a national survey indicated that diabetic status was positively associated with the length of stay and hospital expenditure after adjusting for possible confounders 53 . In comparison, in fast‐growing economies, such as Ethiopia, 19.76% (95% CI; 16.2–23.8) of the study population (420 DM patients) developed AKI, with a median follow‐up period of 30.75 months 40 .…”