Abstract
BACKGROUND/OBJECTIVE: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among patients with diabetes mellitus (DM). Although ASCVD risk is elevated in diabetic populations, the effect of acute kidney injury (AKI), especially when chronic kidney disease (CKD) is present, on post-ASCVD outcomes remain unclear. This study investigates the association between AKI-with or without co-existing CKD-and short-term adverse outcomes in diabetic patients following their first ASCVD event. METHODS: This retrospective cohort study analyzed data from the Taipei Medical University Clinical Research Database (2004-2020), which includes anonymized electronic health records from three affiliated hospitals. Patients with DM who experienced the first ASCVD event were categorized by kidney function: no known kidney disease (NKD), AKI, CKD, and acute-on-CKD (AoCKD). The impact of kidney dysfunction on outcomes was assessed using Cox proportional-hazards models, with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Out of 4525 patients, those with CKD and AoCKD exhibited significantly higher 1-year all-cause mortality (HR: 1.24 and 1.68, respectively) and risks of cardiovascular death, recurrent ASCVD-related hospitalizations, and heart failure, compared with NKD patients. Diuretic use was associated with increased all-cause mortality in AoCKD and CKD groups. In the contrary, the use of metformin was associated with a lower risk of all-cause mortality in AoCKD and CKD groups. CONCLUSION: AoCKD significantly increases short-term mortality and cardiovascular complications in diabetic patients post-ASCVD period, whereas AKI alone does not confer additional risk. These findings highlight the need for dedicated case-managed, personalized and multidisciplinary interventions for cardiorenal health. The early nephrologist consultation, echocardiography with speckle-tracking strain, urine albumin-to-creatinine ratio, pharmacologic strategies, such as cautious use of diuretics, use of sodium-glucose transport protein 2 inhibitors, statin or metformin are recommended to improve outcomes in this high-risk group.