{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:59Z","timestamp":1783491539108,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Elderly critically ill ICU patients with CKD face high mortality. The independent and combined prognostic roles of glycemic variability (Glucose CV) and calcium-phosphate metabolic disorders in this population remain unconfirmed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study contained three cohorts: MIMIC-IV (\n                      <jats:italic>n<\/jats:italic>\n                      = 1,319, development), multicenter eICU (\n                      <jats:italic>n<\/jats:italic>\n                      = 996, validation), and Chinese hospital cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 1,069, clinical validation). Multivariable Cox regression and meta-analysis were applied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Elevated Glucose CV independently predicted 28- and 90-day mortality with predominant early risk. Concurrent hypocalcemia and hyperphosphatemia indicated the poorest prognosis, and high GV produced synergistic harmful effects in this subgroup. All results were verified by external cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Targeted glycemic variability management and calcium-phosphate homeostasis correction may effectively improve survival of elderly critically ill CKD patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1826900","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:30Z","timestamp":1783490310000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined impact of glucose variability and mineral disorders on mortality and severe cardiorenal events in critically ill CKD patients: a multicenter cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yingyun","family":"Peng","sequence":"first","affiliation":[{"name":"Health Management Center, Affiliated Jinhua Hospital, Zhejiang University School of Medicine","place":["Jinhua, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxi","family":"Jia","sequence":"additional","affiliation":[{"name":"Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital","place":["Jinhua, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Jinhua Hospital Affiliated to Zhejiang University","place":["Jinhua, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of General Practice, People\u2019s Hospital of Chongqing Hechuan","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"106006","DOI":"10.1016\/j.archger.2025.106006","article-title":"Global and regional drivers of chronic kidney disease burden in older adults: the dominant role of high fasting plasma glucose and the rise of obesity in China","volume":"139","author":"Gu","year":"2025","journal-title":"Arch Gerontol Geriatr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s11255-023-03675-1","article-title":"Characteristics of hospitalized elderly patients with CKD: a comparison between elderly and non-elderly CKD based on a multicenter cross-sectional study","volume":"56","author":"Liang","year":"2024","journal-title":"Int Urol Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"949","DOI":"10.3390\/ijms25020949","article-title":"Focus on mitochondrial respiratory chain: potential therapeutic target for chronic renal failure","volume":"25","author":"Wang","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e73353","DOI":"10.7759\/cureus.73353","article-title":"Increased risk of Alzheimer's disease with glycemic variability: a systematic review and meta-analysis","volume":"16","author":"Gonzales","year":"2024","journal-title":"Cureus"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"110722","DOI":"10.4239\/wjd.v16.i10.110722","article-title":"Blood glucose variability impacts heart rate dynamics in older type 2 diabetic and coronary heart disease patients","volume":"16","author":"Li","year":"2025","journal-title":"World J Diabetes"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/MNH.0000000000000611","article-title":"Circadian rhythms of mineral metabolism in chronic kidney disease-mineral bone disorder","volume":"29","author":"Egstrand","year":"2020","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.3390\/jcm11051335","article-title":"Chronic renal failure and cardiovascular disease: a comprehensive appraisal","volume":"11","author":"Skalsky","year":"2022","journal-title":"J Clin Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.transproceed.2023.03.034","article-title":"Evaluation of bone mineral metabolism after liver transplantation by bone mineral densitometry and biochemical markers","volume":"55","author":"Sarici","year":"2023","journal-title":"Transplant Proc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1111\/nep.13910","article-title":"Misclassification of calcium status in end-stage kidney disease using albumin-adjusted calcium levels","volume":"26","author":"Law","year":"2021","journal-title":"Nephrology (Carlton)"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2026-0545","article-title":"Albumin-adjusted (\"corrected\") calcium should no longer be reported: a position statement from the joint IOF working group and IFCC committee on bone metabolism and EFLM committee on CKD","volume":"64","author":"Cavalier","year":"2026","journal-title":"Clin Chem Lab Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e22589","DOI":"10.1002\/jcla.22589","article-title":"Predictive accuracy of serum total calcium for both critically high and critically low ionized calcium in critical illness","volume":"32","author":"Hu","year":"2018","journal-title":"J Clin Lab Anal"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"111813","DOI":"10.4239\/wjd.v16.i10.111813","article-title":"Diabetic bone fragility through advanced glycation end product-collagen axis: mechanisms and therapy of sodium glucose cotransporter 2 inhibitors","volume":"16","author":"Li","year":"2025","journal-title":"World J Diabetes"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1595228","DOI":"10.3389\/fendo.2025.1595228","article-title":"Research progress of diabetic osteoporosis: a comprehensive review","volume":"16","author":"Ma","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3225","DOI":"10.2337\/db16-0053","article-title":"Regulation of glucose handling by the skeleton: insights from mouse and human studies","volume":"65","author":"Liu","year":"2016","journal-title":"Diabetes"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e2024103","DOI":"10.1590\/1516-3180.2024.0103.03072024","article-title":"The relationship between insulin resistance and fibroblast growth factor 23 in patients with non-diabetic pre-dialysis chronic kidney disease: a cross-sectional study","volume":"143","author":"Durak","year":"2025","journal-title":"Sao Paulo Med J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1002\/jcsm.12218","article-title":"Vitamin D, a modulator of musculoskeletal health in chronic kidney disease","volume":"8","author":"Molina","year":"2017","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1007\/s11914-021-00715-6","article-title":"Fracture patterns in type 1 and type 2 diabetes mellitus: a narrative review of recent literature","volume":"19","author":"Van Hulten","year":"2021","journal-title":"Curr Osteoporos Rep"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s12933-025-02751-3","article-title":"Relationship between stress hyperglycaemic ratio (SHR) and critical illness: a systematic review","volume":"24","author":"Song","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/s00223-013-9752-4","article-title":"Control of bone remodeling by the peripheral sympathetic nervous system","volume":"94","author":"Elefteriou","year":"2014","journal-title":"Calcif Tissue Int"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1186\/s12933-024-02502-w","article-title":"Elevated glucose levels increase vascular calcification risk by disrupting extracellular pyrophosphate metabolism","volume":"23","author":"Flores-Roco","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2998","DOI":"10.3390\/nu15132998","article-title":"The mutual interplay between bone, glucose and lipid metabolism: the role of vitamin D and PTH","volume":"15","author":"Danese","year":"2023","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/MNH.0000000000001078","article-title":"Fibroblast growth factor 23 as a risk factor for incident diabetes","volume":"34","author":"de Borst","year":"2025","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2583","DOI":"10.3390\/jcm10122583","article-title":"Pathophysiological implications of imbalances in fibroblast growth factor 23 in the development of diabetes","volume":"10","author":"Donate-Correa","year":"2021","journal-title":"J Clin Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"F210","DOI":"10.1152\/ajprenal.1990.259.2.F210","article-title":"Mechanisms of impaired insulin secretion after chronic excess of parathyroid hormone","volume":"259","author":"Perna","year":"1990","journal-title":"Am J Phys"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"882998","DOI":"10.3389\/fendo.2022.882998","article-title":"The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors: a Danish nationwide cohort study","volume":"13","author":"Al-Mashhadi","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e2335797","DOI":"10.1001\/jamanetworkopen.2023.35797","article-title":"Sodium-glucose cotransporter 2 inhibitors vs incretin-based drugs and risk of fractures for type 2 diabetes","volume":"6","author":"Ko","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e1025","DOI":"10.1097\/CCE.0000000000001025","article-title":"Glycemic variability as a prognostic factor for mortality in patients with critical illness: a systematic review and Meta-analysis","volume":"6","author":"Hryciw","year":"2024","journal-title":"Crit Care Explor"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1007\/s00134-024-07663-6","article-title":"Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review","volume":"50","author":"Nielsen","year":"2024","journal-title":"Intensive Care Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/j.eprac.2024.06.004","article-title":"Performance of continuous glucose monitoring in patients with acute respiratory failure: a prospective, single-Center observational study","volume":"30","author":"Liu","year":"2024","journal-title":"Endocr Pract"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1089\/dia.2024.0035","article-title":"Performance of subcutaneous continuous glucose monitoring in adult critically ill patients receiving vasopressor therapy","volume":"26","author":"Friman","year":"2024","journal-title":"Diabetes Technol Ther"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826900\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:31Z","timestamp":1783490311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826900\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1826900"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1826900","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1826900"}}