The prognostic impact of the Stress Hyperglycemia Ratio on End‐Stage Renal Disease among patients with Diabetic Kidney Disease

医学 内科学 队列 终末期肾病 糖尿病 比例危险模型 肾脏疾病 蛋白尿 危险系数 肾功能 入射(几何) 回顾性队列研究 队列研究 疾病 内分泌学 置信区间 物理 光学
作者
Yutong Zou,Qing Yang,Yanlin Lang,Lei Zhu,Jiamin Yuan,Jia Yang,Zhonglin Chai,Mark E. Cooper,Fang Liu
出处
期刊:Diabetes, Obesity and Metabolism [Wiley]
标识
DOI:10.1111/dom.16056
摘要

Abstract Background The Stress Hyperglycemia Ratio (SHR), a new biomarker calculated from glucose and HbA1c levels, has been linked to significant clinical outcomes in diabetes. This study investigates the potential of the SHR to predict End‐Stage Renal Disease (ESRD) among patients with Diabetic Kidney Disease (DKD). Methods We included 316 participants from the West China Hospital T2DM‐DKD cohort (January 2008–September 2020), divided into three SHR tertiles: T1 (SHR <0.7), T2 (SHR ≥0.7 to <0.94) and T3 (SHR ≥0.94). A second retrospective cohort of 625 DKD patients was recruited from Sichuan University Hospital (January 2019–May 2022), with similar inclusion criteria. SHR was analysed using Restricted Cubic Spline, Kaplan–Meier curves and Cox proportional hazards models. Key confounders such as eGFR, proteinuria, hypoalbuminemia and glucose‐lowering medications were adjusted for in the analysis. Results In Cohort 1 (median follow‐up 42 months), 38.6% developed ESRD. Kaplan–Meier curves showed a higher incidence of ESRD in the lowest and highest SHR tertiles compared to the middle group ( p < 0.01). Multivariate analysis confirmed that SHR <0.7 (HR 1.71, 95% CI: 1.01–2.90) and SHR ≥0.94 (HR 1.93, 95% CI: 1.16–3.20) were significantly associated with ESRD. In Cohort 2 (median follow‐up 18.6 months), patients with SHR <0.7 and ≥0.94 had significantly higher risks of ≥30% eGFR decline or ESRD, with adjusted HRs of 2.18 (95% CI: 1.15–4.11) and 2.68 (95% CI: 1.38–5.23), respectively. Conclusion This study observed a U‐shaped relationship between SHR and ESRD in patients with DKD. Both very high and very low SHR values correlate with increased risks, highlighting the critical importance of glucose management in chronic diabetes care.
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