Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus: Epidemiology, Risk Factors, and Outcomes in a Tertiary Care Public Sector Hospital in South India

Abstract

Background: Acute kidney injury (AKI) is a common and serious complication among patients with type 2 diabetes mellitus (T2DM), contributing significantly to morbidity, mortality, prolonged hospitalisation, and progression to chronic kidney disease (CKD). Data on the epidemiology and outcomes of AKI in patients with diabetes from resource-limited public-sector settings in South India remain sparse. Aim: This study evaluated the epidemiology, risk factors, severity, and in-hospital outcomes of AKI in patients with T2DM at a tertiary public-sector hospital in South India. Methods: This prospective observational study was conducted in the Department of Nephrology, Gandhi Hospital, Hyderabad, over 36 months (January 2023–December 2025). All patients aged >18 years with AKI and pre-existing T2DM who were admitted to the Department of Nephrology were included; those with CKD receiving maintenance haemodialysis were excluded. AKI severity was staged using KDIGO criteria. Baseline demographic, clinical, and biochemical parameters were recorded, and primary outcomes (all-cause mortality and requirement for renal replacement therapy [RRT]) and the secondary outcome (renal recovery) were assessed. Results: Of 7,193 nephrology admissions over the study period, 844 patients with AKI and pre-existing T2DM were analysed. The mean age was 46 ± 9 years, with a male predominance (69%). KDIGO stage 3 AKI was present in 61% of patients at presentation. Urosepsis (59% in stage 3 vs. 29% in stage 1, p<0.001) and sepsis (51% in stage 3, p<0.001) were the leading precipitants, and their frequency increased significantly with AKI severity, as did fluid overload, the need for inotropic support, and leukocytosis. RRT was required in 514 patients (61%), most commonly as a combination of peritoneal dialysis and haemodialysis (64%). In-hospital mortality was 12% overall. Non-survivors had a significantly longer duration of diabetes and a higher prevalence of hypertension and pre-existing CKD than survivors (p<0.05). Among patients discharged alive, incomplete renal recovery was common. Conclusion: AKI in patients with T2DM at this public-sector tertiary care centre in South India was characterised by advanced severity at presentation, a predominantly infective aetiology, and a substantial requirement for renal replacement therapy. Pre-existing CKD, longer duration of diabetes, and hypertension were associated with mortality. Early identification and prompt management of infections in patients with diabetes may improve outcomes.