Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women

Abstract

Hultdin (2021): Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women,

Shrunken Pore Syndrome Is Associated with Renal Function Decline in Female Patients with Kidney Diseases

“…The selectively accumulated proteins consist of cytokines, hormones, growth factors, and signaling peptides, many of which have proatherosclerotic effects as corroborated by proteomic studies [ 33 , 34 ]. Accordingly, most studies concerning SPS demonstrated adverse cardiovascular endpoints [ 19 , 20 , 35 ]. However, few studies conducted so far related SPS to renal outcomes, and our study was the first one to our knowledge that assess the relationship between SPS and ESRD or eGFR decline in patients suffering kidney diseases of known pathological diagnoses.…”

“…Both 60% and 70% eGFRcys/eGFRcr ratio have been used in previous studies [ 14 , 15 , 17 ]. Continuous ratio has also been explored in some researches where the above cut-off values identified few patients [ 19 , 20 , 36 ]. We chose the cut-off value of 70% as previous studies have shown that adverse effects already come into play in early stage when eGFRcys/eGFRcr ratio falls to 85% or 90% [ 16 , 18 ].…”

“…Sex difference was observed in our study, as the prevalence of SPS was lower but the HR was significant in women compared to men. Sex-related difference has been reported in some researches: a lower eGFRcys/eGFRcr ratio was shown to be hazardous in the development of first-ever myocardial infarction [ 19 ] and aortic stenosis requiring surgery [ 20 ] only in women but not in men. However, the present study was the first one to our knowledge reporting sex differences of SPS regarding renal outcomes.…”

“…So far, SPS has been identified in diverse populations from pregnant women [ 9 ] to patients with heart failure [ 13 ], hip fracture [ 14 ], undergoing cardiac surgery [ 15 , 16 ], and even seemingly healthy ones [ 17 , 18 ]. Detrimental health effects have been characterized in almost all related researches concerning various outcomes such as morbidity [ 17 ], mortality [ 13 , 16 ], rehospitalization [ 13 ], and cardiovascular events [ 19 , 20 ]. Yet, SPS has rarely been investigated in patients with kidney diseases, and its relation to renal outcomes has not been clearly elucidated.…”

The complexity of kidney disease and diagnosing it – cystatin C, selective glomerular hypofiltration syndromes and proteome regulation

“…According to the pore model for glomerular filtration [72,73], these observations could be explained by a shrinking (or elongation) of the pores [71]. Almost immediately after this observation, the presence of shrunken pore syndrome and/or an eGFR cystatin C /eGFR creatinine -ratio significantly below 1 was found to be strongly correlated to mortality, morbidity, heart failure and end-stage renal disease [63,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]. Similar observations between an abnormally low eGFR cystatin C /eGFR creatinine -ratio and morbidity have recently been described in an American study, although it used the difference between eGFR cystatin C and eGFR creatinine to identify a specific reduction in the excretion of 5-30 kDa molecules [89,90].…”