The hemodynamic gain index (HGI), a novel non-invasive hemodynamic marker, represents a promising advancement in cardiovascular risk assessment. Cardiovascular disease and chronic kidney disease (CKD) are closely intertwined and share bidirectional relationships. We aimed to assess the association of HGI with CKD risk in a prospective study. Hemodynamic gain index was calculated using heart rate and systolic blood pressure (SBP) responses measured in 1765 men aged 42–61 years with normal kidney function during exercise testing using the formula: [(Heart rate_max x SBP_max)—(Heart rate_rest x SBP_rest)]/(Heart rate_rest x SBP_rest). Multivariable adjusted hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for CKD. Over a median follow-up duration of 25.9 years, 175 CKD cases occurred. In analysis adjusted for established risk factors, a unit (bpm/mmHg) higher HGI was associated with a decreased risk of CKD (HR 0.78, 95% CI 0.65–0.95). Comparing extreme tertiles of HGI, the corresponding adjusted HR (95% CI) for CKD was 0.53 (0.33–0.85). Addition of HGI to a CKD risk prediction model containing established risk factors improved risk discrimination and reclassification (p-value for difference in -2 log likelihood = .011; net-reclassification-improvement = 59.37%, p = .018; integrated-discrimination-improvement = 0.0064, p = .008). Higher HGI is associated with a lower CKD risk and improves the prediction and classification of CKD beyond common established risk factors.

血流动力学增益指数（HGI）是一种新型非侵入性血流动力学标记物，代表了心血管风险评估的一个有希望的进步。心血管疾病和慢性肾脏病（CKD）紧密相连并具有双向关系。我们的目的是在一项前瞻性研究中评估 HGI 与 CKD 风险的关联。血流动力学增益指数是通过在运动测试期间测量 1765 名 42-61 岁、肾功能正常的男性的心率和收缩压 (SBP) 反应来计算的，公式为：[(_最大心率x SBP_{最大)—(静息}心率x 休息收缩压_{） ]/（休息}心率x 休息收缩压_）。估计 CKD 的多变量调整风险比 (HR)（95% 置信区间，CI）。在中位随访时间 25.9 年中，发生了 175 例 CKD 病例。在根据既定风险因素进行调整的分析中，HGI 升高一个单位 (bpm/mmHg) 与 CKD 风险降低相关（HR 0.78，95% CI 0.65–0.95）。比较 HGI 的极端三分位数，CKD 的相应调整 HR (95% CI) 为 0.53 (0.33–0.85)。将 HGI 添加到包含既定风险因素的 CKD 风险预测模型中，改善了风险辨别和重新分类（ -2 对数似然差异的p值 = .011；净重分类改进 = 59.37%，p  = .018；综合辨别-改进 = 0.0064，p  = .008）。较高的 HGI 与较低的 CKD 风险相关，并改善了 CKD 的预测和分类，超越了常见的既定风险因素。