J Bras Nefrol. 2025 Oct-Dec;47(4):e20250028. doi: 10.1590/2175-8239-JBN-2025-0028en.
ABSTRACT
INTRODUCTION: Stress hyperglycemia in patients with sepsis has not been consistently associated with an increased risk of acute kidney injury (AKI).
OBJECTIVE: To evaluate the effect of blood glucose levels on the occurrence of AKI requiring dialysis in critically ill patients with sepsis.
METHODS: Retrospective cohort study of patients with sepsis admitted to the ICU of a private hospital between December 2017 and August 2021. Clinical, laboratory, and severity variables were collected. Mean blood glucose levels in the first week of ICU stay (primary exposure variable) were stratified into tertiles. The effect of blood glucose on the occurrence of dialysis-requiring AKI was assessed using multivariate logistic regression.
RESULTS: Of the 1,317 patients evaluated, 86.6% had clinical conditions as the underlying cause of sepsis. AKI requiring hemodialysis occurred in 12.2% of the sample. Patients with mean blood glucose levels above the third tertile (≥160 mg/dl), compared to those with mean blood glucose levels below the first two tertiles (<160 mg/dl), had a higher prevalence of diabetes (69.1% vs. 7.1%; p < 0.001). Patients with mean blood glucose levels ≥160 mg/dl had a 62% higher odds of developing AKI requiring dialysis compared to those with mean blood glucose levels < 160 mg/dl (crude OR = 1.62; 95% CI 1.16-2.26; p = 0.005). After adjustment for other variables, mean blood glucose levels ≥180 mg/dl did not increase the likelihood of AKI (OR = 1.27; 95% CI 0.76-2.12; p = 0.359).
CONCLUSION: In this patient group, sepsis and mean blood glucose levels ≥160 mg/dl were not independently associated with the occurrence of dialysis-requiring AKI.
PMID:40779693 | DOI:10.1590/2175-8239-JBN-2025-0028en
