Frontiers in medicine · 2026
Stress hyperglycemia ratio (SHR) and triglyceride-glucose index (TYG) associated with renal response to finerenone in diabetic kidney disease: a retrospective cohort study.
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Chen Anqi, Zou Liting, Sun Wei, Yao Xuelian, Qian Xinfeng, Shao Fang
Аннотация
BACKGROUND: Diabetic kidney disease (DKD) is a major complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage kidney disease (ESKD). This study aimed to investigate the association between stress hyperglycemia ratio (SHR) and triglyceride-glucose (TyG) index with renal outcomes in patients with Chronic Kidney Disease (CKD) initiating finerenone therapy.
METHODS: This retrospective cohort study included 387 adults with DKD and CKD stages 1-4 who initiated finerenone therapy between January 2023 and December 2025. The primary composite renal endpoint included sustained ≥40% eGFR decline or progression to ESKD. Secondary outcomes were absolute UACR change at 12 months and annualized eGFR decline rate. Cox proportional hazards models evaluated their associations with renal outcomes, adjusted for clinical covariates.
RESULTS: The primary endpoint was reached by 62 patients (16.0%). Higher baseline SHR and TyG were associated with worse renal outcomes. In multivariable analysis, the highest SHR tertile (T3) had a 2.52-fold increased risk (95% CI 1.48-4.29; p = 0.001) and the highest TyG tertile (T3) had a 1.96-fold increased risk (95% CI 1.22-3.15; p = 0.006) compared to the lowest tertiles. Subgroup analyses showed stronger associations in advanced CKD stages. At 12 months, high-index groups had attenuated UACR reduction and accelerated eGFR decline. Adding SHR and TyG to the clinical model improved predictive performance, with a C-statistic increase from 0.70 to 0.78.
CONCLUSION: Higher SHR and TyG values were independently associated with worse renal outcomes in patients with DKD initiating finerenone therapy. These biomarkers could enhance predictive models and inform targeted interventions.
METHODS: This retrospective cohort study included 387 adults with DKD and CKD stages 1-4 who initiated finerenone therapy between January 2023 and December 2025. The primary composite renal endpoint included sustained ≥40% eGFR decline or progression to ESKD. Secondary outcomes were absolute UACR change at 12 months and annualized eGFR decline rate. Cox proportional hazards models evaluated their associations with renal outcomes, adjusted for clinical covariates.
RESULTS: The primary endpoint was reached by 62 patients (16.0%). Higher baseline SHR and TyG were associated with worse renal outcomes. In multivariable analysis, the highest SHR tertile (T3) had a 2.52-fold increased risk (95% CI 1.48-4.29; p = 0.001) and the highest TyG tertile (T3) had a 1.96-fold increased risk (95% CI 1.22-3.15; p = 0.006) compared to the lowest tertiles. Subgroup analyses showed stronger associations in advanced CKD stages. At 12 months, high-index groups had attenuated UACR reduction and accelerated eGFR decline. Adding SHR and TyG to the clinical model improved predictive performance, with a C-statistic increase from 0.70 to 0.78.
CONCLUSION: Higher SHR and TyG values were independently associated with worse renal outcomes in patients with DKD initiating finerenone therapy. These biomarkers could enhance predictive models and inform targeted interventions.