Clinical Report: Joint Effects of Glucose Fluctuations and Mineral Imbalances

Overview

This study investigates the independent and combined prognostic roles of glycemic variability and calcium-phosphate metabolic disorders in critically ill patients with chronic kidney disease (CKD).

Background

Elderly critically ill patients with CKD are at high risk for mortality and adverse outcomes, which places a significant burden on healthcare systems. Traditional management strategies often focus on individual metabolic parameters.

Data Highlights

Key Findings

• Elevated glucose variability (Glucose CV) independently predicts 28- and 90-day mortality.
• Concurrent hypocalcemia and hyperphosphatemia indicate the poorest prognosis.
• High glucose variability has synergistic harmful effects in patients with mineral imbalances.
• Results were verified across multiple external cohorts.

Clinical Implications

Clinicians should consider both glycemic variability and mineral imbalances when assessing the prognosis of elderly critically ill patients with CKD.

Conclusion

The findings emphasize the need for targeted interventions addressing both glucose fluctuations and mineral imbalances.

Related Resources & Content

1. Frontiers in Endocrinology, 2026 -- Impact of the longitudinal evolution of impaired fasting glucose on cardio-kidney-metabolic multimorbidity
2. European Journal of Preventive Cardiology, 2023 -- Cardiovascular–kidney–metabolic syndrome and mortality in a prospective UK cohort study
3. 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
4. Diabetes Care, 2026 -- Diabetes Care in the Hospital: Standards of Care in Diabetes
5. KDIGO, 2026 -- KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)
6. The Journal of Clinical Endocrinology & Metabolism — Decline in Glomerular Filtration Rate as a Predictor of Overall Mortality and Its Mediating Role in Tryptophan Metabolism's Impact on Mortality Risk in Type 2 Diabetes
7. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 | Diabetes Care | American Diabetes Association
8. KISU_v7_i1_COVER.indd
9. The association between albumin corrected calcium levels and mortality in ICU patients undergoing maintenance hemodialysis | Scientific Reports
10. Change trends in serum phosphate levels predict in-hospital mortality in critically ill septic patients | Scientific Reports
11. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)