This observational study will collect clinical and laboratory information from hospitalized patients with chronic kidney disease to identify diabetes mellitus and selected metabolic findings during hospitalization

Hospitalized adult patients with chronic kidney disease will be included in this observational study. Information routinely recorded during hospitalization will be collected. This information will include the presence of diabetes mellitus and laboratory values related to blood glucose levels, electrolyte levels, and acid base balance. No study related interventions will be performed.

Inclusion Criteria:

• Age greater than or equal to 18 years
• Known chronic kidney disease, defined as baseline estimated glomerular filtration rate less than 60 milliliters per minute per 1.73 square meters for at least 3 months, or documented chronic kidney disease stage 3 to 5 by prior medical records
• Hospitalized for any medical reason
• Consent provided

Exclusion Criteria:

• Acute single episode of reversible acute kidney injury with previously normal renal function (no established chronic kidney disease)
• Admission for palliative care or expected survival less than 24 hours
• Pregnancy

A) Inclusion criteria:

• Age ≥18 years.
• Known CKD (baseline eGFR <60 mL/min/1.73 m² for ≥3 months) OR documented CKD stage 3-5 by prior records.
• Hospitalized for any medical reason.
• Consent provided.

B) Exclusion criteria:

• Acute single episode of reversible AKI with previously normal renal function (no established CKD).
• Admission for palliative care /expected survival <24 hours.
• Pregnancy.

C) Patient groups (for analysis):

Diabetes status:

• Diabetic CKD (known diagnosis or on antidiabetic therapy prior to admission).
• Non-diabetic CKD.

D) Subgroups / Diabetic patient group: Metabolic derangement categories

1. Acute hyperglycemia

   • Diabetic ketoacidosis (DKA) /hyperosmolar hyperglycemic state (HHS)
   • Patients without DKA or HHS

2. Hypoglycemia

   • Hypoglycemia: any blood glucose <70 mg/dL (and severe <40 mg/dL).
   • Without Hypoglycemia episodes

3. Metabolic acidosis arterial or venous HCO₃- <20 mmol/L or pH <7.35 with anion gap >12 as appropriate.