Diabetes Care · Mar 17, 2026
Shrunken Pore Syndrome and Risk of Cardiovascular Disease and All-Cause Mortality in Individuals With Type 1 Diabetes With and Without Albuminuria
By Harjutsalo V, Thorn LM, Sandholm N et al.
OBJECTIVE: To investigate the association between "shrunken pore syndrome" (SPS), defined as a large discrepancy between estimated glomerular filtration rates based on cystatin C (eGFRcys) and creatinine (eGFRcr), and coronary artery disease (CAD), stroke, peripheral artery disease (PAD), heart failure (HF), and all-cause mortality in individuals with T1D with and without albuminuria. RESEARCH DESIGN AND METHODS: The study comprised 3,769 individuals with and without albuminuria from the Finnish Diabetic Nephropathy Study (FinnDiane) who had both serum creatinine (Scr) and serum cystatin C (SCysC) data available. RESULTS: SPS (eGFRcys/eGFRcr ratio cutoff 0.7) was not associated with CAD or stroke. In those with SPS but without albuminuria, the hazard ratios (HRs) for HF, PAD, and all-cause mortality were 3.07 (95% CI 1.47-6.38), 3.64 (95% CI 1.75-7.57), and 3.08 (95% CI 1.86-5.11). The associations between the eGFRcys/eGFRcr ratio as a continuous variable, as well as eGFRcys alone and HF, PAD, and all-cause mortality were significant in those without albuminuria. In individuals with albuminuria, SPS was only associated with HF (HR 1.54; 95% CI 1.02-2.33), whereas the eGFRcys/eGFRcr ratio as a continuous variable was not associated with any of the outcomes. On the contrary, both eGFRcys and eGFRcr were independently associated with all studied outcomes in those with albuminuria. CONCLUSIONS: Findings highlight the clinical potential of identifying individuals at increased risk of HF, PAD, and all-cause mortality at an early stage among those with T1D without albuminuria by evaluating both eGFRcys and eGFRcr and their discrepancy.