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% ( 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.