Association between stress hyperglycemia ratio and acute kidney injury in patients with chronic cardiovascular-kidney disorder: a multi-center retrospective cohort study from China.

Abstract

Aim: Stress hyperglycemia ratio (SHR) is associated with acute kidney injury (AKI) among patients with myocardial infarction. However, the relationship between SHR and AKI in chronic cardiovascular-kidney disorder (CCV-KD) patients are still unknown. This study aimed to clarify the association of SHR with adverse renal outcomes in CCV-KD patients.

Method: 6,359 CCV-KD patients from the Chinese multi-center registry cohort Cardiorenal ImprovemeNt II (CIN-II) were included in this study. We categorized SHR into distinct groups and conducted logistic analyses to evaluate its association with AKI and progression to end-stage kidney disease (ESKD) or in-hospital dialysis. We also calculated the incidence of these adverse renal outcomes, stratified by estimated glomerular filtration rate (eGFR). Additionally, restricted cubic spline (RCS) was performed to understand the relationship between SHR and adverse renal outcomes.

Result: In this study, 13.7% patients experienced AKI and 4.3% patients progressed to ESKD or in-hospital dialysis. Both low SHR (< 0.7) and high SHR (≥ 1.1) were associated with a significantly increased risk of AKI. In addition, high SHR was strongly correlated with an increasing risk of progression to ESKD/dialysis during hospitalization. The incidence of AKI was lowest when the SHR was between 0.9 and 1.1, while the incidence of ESKD was highest when the SHR was ≥ 1.1, across all eGFR subgroups.

Conclusion: In patients with CCV-KD, both low and high SHR are associated with an increased risk of AKI development, and elevated SHR is associated with the risk of ESKD/dialysis as well.