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Abstract: PO1390

Shrunken Pore Syndrome: Prevalence and Association with Mortality in a Population-Based Cohort of Elderly Women

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Malmgren, Linnea, Lunds Universitet, Lund, Sweden
  • Mcguigan, Fiona, Lunds Universitet, Lund, Sweden
  • Christensson, Anders, Lunds Universitet, Lund, Sweden
  • Åkesson, Kristina, Lunds Universitet, Lund, Sweden
Background

Decreased kidney function results in lower clearance and increased plasma concentration of a GFR marker. So far creatinine has been the commonly used GFR marker but cystatin C becomes more common. Shrunken pore syndrome (SPS) is a recently identified kidney syndrome characterized by disturbed filtration of mid-sized molecules (5-30 kDa) compared to smaller ones (<0.9 kDa) (Fig1). Resulting in increased plasma levels of cystatin C (cysC) compared to creatinine. SPS is associated with increased risk of cardiovascular disease (CVD) and increased mortality risk. So far few data are available about SPS in population-based cohorts.

Methods

75-yr old women (n=849) from the population-based Osteoporosis Prospective Risk Assessment (OPRA-) cohort, with follow-up after 5yr and 10yr were studied. eGFR was calculated with the CKD-EPI equation. SPS was defined as eGFRcysC/eGFRcrea ratio <0.6 and mortality risk (HR [95% CI]) estimated. Women with sarcopenia or on glucocorticoids were excluded.

Results

Almost 1 in 10 women (9%) had SPS at age 75 but at age 80 the majority of these women had increased their eGFRcysC/eGFRcrea ratio >0.6 (range from 0.6-1.0). Women with SPS had higher 10-yr mortality risk compared with ratios >0.9 (HRadj 1.7 [95% CI, 1.1-2.6]). Table 1.

Conclusion

SPS defined as eGFRcysC/eGFRcrea ratio <0.6 is common in elderly women and associated with increased mortality. While longitudinal data indicate that the state may be reversible. Our results also confirm other studies and suggest that SPS may be a clinically applicable tool to assess mortality risk in the elderly.

SPS (eGFRcysC/eGFRcrea ratio <0.6) is associated with increased 10-yr mortality
 eGFRcysC/eGFRcrea Ratio (age 75)
 n=366
≥0.9
n=178
0.8-0.89
n=140
0.7-0.79
n=85
0.6-0.69
n=80
<0.6
Model 1*1 (ref)1.0 [0.7-1.4]1.0 [0.6-1.4]1.3 [0.8-2.0]1.7 [1.1-2.6]**

*Adjusted for: diabetes, high blood pressure, CVD, smoking. **p=0.016

Possible pathophysiological mechanisms of SPS (1) reduced pore size and (2) thickening of the glomerular basement membrane

Funding

  • Private Foundation Support