Abstract
ObjectiveWe aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients.MethodsClinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model.ResultsThe development cohort enrolled 730 patients with a median follow-up time of 87 (40–98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043–1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951–0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678–13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930–0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287–3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p < 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839–0.921) and 0.798 (95% CI = 0.720–0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability.ConclusionWe developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI.
Highlights
In recent years, the incidence of diabetes has increased globally
Diabetic patients with acute kidney injury (AKI) without timely treatment will progress to chronic renal failure (CRF) and even end-stage renal disease (ESRD), which should be treated by renal replacement therapy (RRT)
AKI is a common complication of diabetes and an independent risk factor associated with the survival rate and CRF of diabetic patients [9,10,11]
Summary
The incidence of diabetes has increased globally. According to the International Diabetes Federation Atlas, 9th edition, 463 million adults worldwide live with diabetes as of 2019, with a prevalence rate of approximately 9.3% and an average annual growth rate of 51% [1]. A large retrospective cohort study has shown that the incidence of AKI is 48.6% in diabetic patients, which is significantly higher than that in non-diabetic patients (17.2%) [6]. Diabetes can increase the incidence of AKI and the risk of poor renal outcomes [7]. One study has shown that the RRT rate of AKI in diabetic patients is approximately 5-fold higher than that in non-diabetic patients [8]. AKI is a common complication of diabetes and an independent risk factor associated with the survival rate and CRF of diabetic patients [9,10,11].
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