Abstract: FR-OR023
Discordance Between Cystatin C-Based eGFR and Creatinine-Based eGFR and Cardiovascular Risk in the FLOW Trial
Session Information
- CKD: Identifying Risks and Optimizing Outcomes
November 07, 2025 | Location: Room 362A, Convention Center
Abstract Time: 05:10 PM - 05:20 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Soveri, Inga, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Mann, Johannes F., KfH Kidney Centre, München, Germany
- Pratley, Richard E., AdventHealth Translational Research Institute, Orlando, Florida, United States
- Schmieder, Roland E., University Hospital Erlangen, Erlangen, Germany
- Cherney, David, University of Toronto, Toronto, Ontario, Canada
- MacIsaac, Richard J., Department of Endocrinology & Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
- Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Capital Region of Denmark, Denmark
- Mahaffey, Kenneth W., Stanford Center for Clinical Research, Department of Medicine, Stanford School of Medicine, Palo Alto, California, United States
- L, Sreenivasamurthy, Lifecare Hospital and Research Centre, Bangalore, India
- Bellary, Srikanth, Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Perkovic, Vlado, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia
- Lim, Soo Kun, University of Malaya, Kuala Lumpur, Malaysia
- Gumprecht, Janusz, Department of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
- Belmar, Nicolas, Novo Nordisk A/S, Søborg, Denmark
- Bosch-Traberg, Heidrun, Novo Nordisk A/S, Søborg, Denmark
- Rasmussen, Soren, Novo Nordisk A/S, Søborg, Denmark
- Tuttle, Katherine R., Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
- Charytan, David M., New York University Grossman School of Medicine, New York, New York, United States
Group or Team Name
- The FLOW Trial Investigators.
Background
Superiority of estimated glomerular filtration rate (eGFR)cystatin C (eGFRcyst) over eGFRcreatinine (eGFRcreat) in cardiovascular risk prediction is established but incompletely understood. It has been hypothesized that low eGFRcyst may be reflecting selective glomerular hypofiltration, characterized by reduced clearance of middle-sized, potentially atherogenic proteins. We analyzed associations of eGFRcyst/eGFRcreat with major adverse cardiovascular events (MACE) and all-cause mortality in participants of the FLOW trial.
Methods
GFR was estimated using the CKD-EPI 2009 (eGFRcreat) or 2012 (eGFRcyst) equations. Time to first event was studied using Cox regression. Baseline eGFRcyst/eGFRcreat <0.7 vs ≥0.7 was a fixed factor and adjusted for eGFRcyst and/or eGFRcreat.
Results
Of the 3463 participants, 1116 (32%) had eGFRcyst/eGFRcreat <0.7 at baseline (median 0.77) (Figure). Median follow-up was 3.4 years. eGFRcyst/eGFRcreat <0.7 was associated with increased risk of MACE and all-cause mortality (unadjusted hazard ratios [95% confidence interval] of 1.58 [1.31−1.90] and 1.87 [1.57−2.23], respectively). The association was preserved after adjustment for baseline eGFRcyst and/or eGFRcreat, with slight attenuation of effect.
Conclusion
In FLOW, eGFRcyst/eGFRcreat <0.7 was associated with substantially increased risk for MACE and all-cause mortality in participants with type 2 diabetes and chronic kidney disease, independent of eGFRcyst. Further research is needed to elucidate potential treatment targets.
Funding
- Commercial Support – Novo Nordisk A/S