For the study, Xiaorui Huang and colleagues from the Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, China, and colleagues retrospectively analyzed data from 2,631 patients admitted with AMI and T2DM between 2018 and 2022. Of these, 76.1% were male, with a median age of 67 years.
The key findings of the study were as follows:
- AKI developed in 13.3% of the cohort, with a higher incidence among women than men (17.2% vs. 12.1%).
- Hyperphosphatemia was the strongest predictor of AKI in males (OR 14.3).
- In females, hyperkalemia (OR 5.88) and higher Killip class were the main risk drivers.
- Higher HbA1c levels were paradoxically associated with reduced AKI risk in both sexes.
- High-density lipoprotein (HDL) has been shown to have a renoprotective effect in women.
- ST-elevation myocardial infarction (STEMI) was linked with a lower likelihood of AKI in both sexes.
- Advanced age, hypoalbuminemia, and elevated fibrinogen were significant predictors of AKI in both groups.
According to the authors, these findings suggest the need for sex-specific surveillance strategies—specifically, close phosphorus monitoring in men and attention to potassium levels and hemodynamic stability in women.
The authors concluded that female sex, older age, and impaired glycemic control may together define a high-risk phenotype for AKI in patients with AMI and T2DM. They suggest that sex-specific risk scores and preventive renal care protocols, especially for elderly diabetic women, could significantly improve outcomes. Furthermore, the study draws attention to the role of hormonal influences, particularly estrogen deficiency, in driving female vulnerability to kidney injury after heart attacks.
While the results are compelling, the team acknowledged several limitations. The retrospective single-center design introduced the possibility of selection bias and residual confounding. Missing data on urinary biomarkers, medication adherence, and dialysis initiation criteria limited the ability to fully account for all risk factors. The authors noted that, despite the large sample size, causal relationships could not be definitively established.
To address these gaps, the researchers proposed future prospective, multicenter studies incorporating advanced methodologies such as target trial emulation, mediation analysis, and machine learning–based risk models. They also called for further exploration of hormonal dynamics and lipid metabolism in shaping sex-specific AKI risk.
"The study highlights the importance of recognizing sex as a critical biological variable in the management of cardiovascular disease and diabetes. Tailoring AKI prevention strategies according to sex could play a pivotal role in improving clinical outcomes for patients with T2DM who experience acute myocardial infarction," the authors wrote.
Reference:
Huang, X., Wang, H., & Yuan, W. (2025). Sex-specific AKI risk in acute myocardial infarction patients with type 2 diabetes mellitus. Frontiers in Endocrinology, 16, 1654587. https://doi.org/10.3389/fendo.2025.1654587
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