The relationship between shrunken pore syndrome and all-cause mortality in people with type 2 diabetes and normal renal function: the Fremantle Diabetes Study Phase II

IF 8.4 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetologia Pub Date : 2025-04-21 DOI:10.1007/s00125-025-06430-6

David G. Bruce, Wendy A. Davis, S. A. Paul Chubb, Timothy M. E. Davis

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引用次数: 0

Abstract

Aims/hypothesis

Estimated GFRs utilising creatinine- (eGFR_creat) or cystatin C-based (eGFR_cyst) equations can generate discrepant results that are associated with clinical outcomes. A low eGFR_cyst/eGFR_creat ratio (<0.60), reflecting a pathological glomerular state termed shrunken pore syndrome (SPS), has been associated with excess mortality in some clinical situations including diabetes. The aim of the present study was to explore this association in a longitudinal observational study of type 2 diabetes with special reference to participants with normal renal function.

Methods

Of 1481 Fremantle Diabetes Study Phase II participants with type 2 diabetes, aged ≥17 years, 1466 had eGFR_creat and eGFR_cyst assessed as part of the baseline assessment and were followed for 10 years or until death, whichever came first. Cox regression modelling was used to determine independent associates of death excluding eGFR; eGFR_cyst/eGFR_creat ratio was then added to this model separately as a categorical or continuous variable. These analyses were also conducted in a subgroup (n=754) of participants with normal renal function (eGFR_creat ≥60 ml/min per 1.73 m² and urinary albumin/creatinine ratio <3 mg/mmol) at baseline.

Results

At entry, the participants had a mean age of 65.9 years, 51.8% were male, the median diabetes duration was 9.0 years and 10.4% had eGFR_cyst/eGFR_creat ratio <0.60 (the definition of SPS). There were 384 deaths (26.2%) during follow-up. The eGFR_cyst/eGFR_creat ratio was independently, significantly and negatively associated with death (adjusted HR [95% CI] 0.91 [0.85, 0.97] for an increase of 0.1, p=0.004). Of eGFR_cyst/eGFR_creat ratio categories, only <0.60 added significantly to the most parsimonious Cox model of time to death (HR [95% CI] 1.56 [1.07, 2.29], p=0.021). In those with normal renal function, 123 (16.3%) died during follow-up. An eGFR_cyst/eGFR_creat ratio <0.60, observed in 57 (7.6%), was also independently associated with mortality (HR [95% CI] 2.55 [1.34, 4.84], p=0.004).

Conclusions/interpretation

A low eGFR_cyst/eGFR_creat ratio is independently associated with mortality in type 2 diabetes, including in people without conventional markers of diabetic kidney disease. The presence of SPS may add clinical value to the risk assessment of people with type 2 diabetes regardless of renal status.

Graphical Abstract

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2型糖尿病患者和肾功能正常的全因死亡率与毛孔萎缩综合征之间的关系：Fremantle糖尿病研究II期

目的/假设使用肌酐（egfrcreate）或胱抑素c （egfr囊肿）方程估计的gfr可能产生与临床结果相关的差异结果。较低的egfr囊肿/eGFRcreat比值（0.60），反映了一种被称为收缩孔综合征（SPS）的病理性肾小球状态，在一些临床情况下，包括糖尿病，与高死亡率有关。本研究的目的是在2型糖尿病的纵向观察研究中探讨这种关联，特别参考了肾功能正常的参与者。方法1481例Fremantle糖尿病研究II期2型糖尿病患者，年龄≥17岁，其中1466例接受eGFRcreat和egfr囊肿评估，作为基线评估的一部分，随访10年或直至死亡，以先到者为准。Cox回归模型用于确定除eGFR外的独立死亡关联因素；然后将egfr囊肿/ egfrcreate比率作为分类变量或连续变量分别添加到该模型中。这些分析也在基线肾功能正常（egfr≥60 ml/min / 1.73 m2，尿白蛋白/肌酐比值≤3 mg/mmol）的参与者亚组（n=754）中进行。结果入组时，参与者的平均年龄为65.9岁，51.8%为男性，糖尿病病程中位数为9.0年，10.4%的患者egfr囊肿/eGFRcreat比值为0.60 （SPS定义）。随访期间死亡384例（26.2%）。egfr囊肿/eGFRcreat比值与死亡呈独立、显著负相关（校正后相对危险度[95% CI] 0.91[0.85, 0.97]，增加0.1,p=0.004）。在egfr囊肿/eGFRcreat比值类别中，只有<；0.60显著增加了死亡时间最简约的Cox模型（HR [95% CI] 1.56 [1.07, 2.29], p=0.021）。在肾功能正常的患者中，123例（16.3%）在随访期间死亡。57例（7.6%）患者的egfr囊肿/eGFRcreat比值为0.60，也与死亡率独立相关（HR [95% CI] 2.55 [1.34, 4.84], p=0.004）。结论/解释低egfr囊肿/eGFRcreat比值与2型糖尿病的死亡率独立相关，包括在没有常规糖尿病肾病标志物的人群中。无论肾脏状况如何，SPS的存在可能为2型糖尿病患者的风险评估增加临床价值。图形抽象

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来源期刊

Diabetologia 医学-内分泌学与代谢

CiteScore

18.10

自引率

2.40%

发文量

193

审稿时长

1 months

期刊介绍： Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.