Stress hyperglycemia ratio: a novel prognostic marker in chronic kidney disease

The stress hyperglycemia ratio (SHR) has recently been suggested to characterize acute glycemic rise better than the admission blood glucose and to be associated with unfavorable outcomes in patients with various cardiovascular diseases. This study aimed to explore the associations between SHR and all-cause or cardiovascular disease (CVD) mortality in patients with chronic kidney disease (CKD).

Adults with CKD participating in the 1999-2018 US National Health and Nutrition Examination Survey with complete SHR and follow-up data were included. SHR was calculated from fasting blood glucose and glycated hemoglobin levels. Associations between SHR and mortality were investigated by weighted multivariable Cox regression analysis.

Among the 3284 participants (mean age 61 years, men prevalence 44.09%) included, 1324 (487 CVD-related) deaths occurred during a median follow-up of 87 months. The restricted cubic spline curve adjusted for all covariates showed a U-shaped and J-shaped association between SHR and all-cause or CVD mortality, respectively, with discernible inflection points at 0.86 and 0.88, respectively. The hazard ratio (95% confidence interval) was 0.117 (0.034-0.404) for SHR < 0.86 and 2.065 (1.328-3.209) for SHR ≥ 0.86 for all-cause mortality, and 0.063 (0.008-0.531) for SHR < 0.88 and 1.551 (0.770-3.124) for SHR ≥ 0.88 for CVD mortality.

We identified U-shaped and J-shaped association between SHR and all-cause or CVD mortality, respectively, in patients with CKD. This result highlights that SHR may be potentially informative for the risk stratification of CKD patients. Given the potential limitations of residual confounding, prospective studies are needed to confirm our findings.