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Journal Article Epublish 1 citation

PubMed: 41098771 DOI: 10.3389/fepid.2025.1661167

Shrunken pore syndrome in relation to morbidity and mortality in the population-based Malmö Diet and Cancer cohort: a generalized propensity score approach.

Front Epidemiol 5:1661167

Authors: Anna Åkesson, Liana Xhakollari, Agnė Laučytė-Cibulskiene, Anders Grubb, Anders Larsson, Amra Jujic, Martin Magnusson, Anders Christensson, Jonas Björk

Affiliations

  • Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden.
  • Department of Laboratory Medicine, Lund University, Lund, Sweden.
  • Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. Department of Nephrology, Skåne University Hospital, Malmö, Sweden.
  • Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
  • Department of Nephrology, Skåne University Hospital, Malmö, Sweden.
  • Department of Clinical Chemistry, Lund University, Lund, Sweden.
  • Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
  • Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
  • Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.
  • Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.

Abstract

PURPOSE

Glomerular filtration rate (GFR) is used for evaluating kidney function. Creatinine and cystatin C levels are the two endogenous substances used to estimate GFR (eGFR CR and eGFR CYS). The agreement between these two is reflected by the eGFR CYS/eGFR CR ratio. An eGFR CYS/eGFR CR ratio <0.70 has been strongly associated with mortality and morbidity. An explanation is a selective decrease in the filtration of substances of different masses, and this condition is referred to as "Shrunken pore syndrome" (SPS). We aim to investigate the prevalence of SPS and its association with morbidity and mortality in a well-characterized population-based cohort.

METHODS

The study population consisted of 5,061 individuals from the Malmö Diet and Cancer cardiovascular cohort (MDC-CC) with baseline examinations between 1991 and 1994 and a median follow-up of 25.3 years (IQR = 5.7). The eGFR CYS/eGFR CR ratio was categorized into four groups and used to estimate a generalized propensity score for SPS to adjust for confounding factors. Individuals were matched to create a quartet (one from each eGFR CYS/eGFR CR ratio category) with similar scores. We related the eGFR CYS/eGFR CR ratio to all-cause mortality, incident cardiovascular disease, incident kidney disease, and incident diabetes using Cox proportional hazards models with shared frailty.

RESULTS

SPS was detected in 405 individuals (8.0%). The hazard ratio (HR) for all-cause mortality was 1.6 [95% confidence interval (CI) 1.3-2.0] when comparing individuals with SPS to the reference group (eGFR CYS/eGFR CR ratio ≥ 1.0). For incident kidney disease, the association seems to stem from a low eGFR CYS rather than the eGFR CYS/eGFR CR ratio. For the other two outcomes, robust and statistically significant associations could not be found.

CONCLUSION

SPS was prevalent among middle-aged, generally healthy, individuals and led to markedly higher mortality during follow-up.

MeSH

Kidney Diseases, Creatinine, Mortality, Neoplasms, Propensity Score, Kidney, Diet, Morbidity