Adults with diabetes or prediabetes remain at elevated risk for acute kidney injury (AKI), although uncertainty persists regarding which insulin resistance (IR) indices best identify individuals at highest risk. A prospective cohort study published in Diabetology & Metabolic Syndrome evaluated whether estimated glucose disposal rate (eGDR) improves AKI risk stratification in individuals with dysglycemia.

The analysis included 60,149 UK Biobank participants with diabetes or prediabetes. eGDR was calculated using waist circumference, hypertension status, and HbA1c, with incident AKI assessed as the primary outcome. The study also compared the predictive performance of eGDR against several conventional IR indices using C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Findings

• Over a median follow-up duration of 13.4 years, 6,259 participants developed AKI.
• Participants in the highest eGDR quartile demonstrated a 62% lower risk of AKI than those in the lowest quartile (adjusted HR: 0.38; 95% CI, 0.34–0.43).
• Each standard deviation increment in eGDR was associated with a 36% lower AKI risk (adjusted HR: 0.64; 95% CI, 0.61–0.66).
• eGDR demonstrated the highest discriminative performance for AKI risk among evaluated insulin resistance indices, with a C-index of 0.709 (95% CI, 0.702–0.715).
• eGDR also demonstrated improvements in net reclassification improvement (NRI, 0.063–0.196) and integrated discrimination improvement (IDI, 0.003–0.018) compared with conventional insulin resistance indices.

The findings suggest that lower eGDR was independently associated with higher AKI risk among adults with diabetes or prediabetes and demonstrated stronger predictive performance than several conventional insulin resistance indices.