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Selective glomerular hypofiltration is associated with glucometabolic disturbances in the general population
Christopher Nilsson1,2, Agne Laucyte-Cibulskiene1,2, Amra Jujic1
1Department of Clinical Sciences, Lund University, Malmö, Sweden.
Journal of Internal Medicine
|August 12, 2026
Summary
Dysglycemia and insulin resistance are linked to a lower cystatin C- to creatinine-based estimated glomerular filtration rate ratio (eGFRcys/eGFRcr), indicating potential kidney vulnerability. This association was observed in a large Swedish population study.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Syndrome
Background:
- Discordance in estimated glomerular filtration rate (eGFR) using cystatin C (eGFRcys) and creatinine (eGFRcr) is associated with adverse outcomes.
- A low eGFRcys/eGFRcr ratio, termed selective glomerular hypofiltration syndrome (SGHS), may indicate early metabolic kidney vulnerability.
Purpose of the Study:
- To investigate the association between dysglycemia, insulin resistance, and the eGFRcys/eGFRcr ratio in a general population.
- To explore the relationship between glycemic status and SGHS prevalence.
Main Methods:
- Analysis of 28,078 participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study.
- Assessment of glycemic status, HbA1c, fasting glucose, and HOMA-IR.
- Use of multivariable regression models to analyze the continuous eGFRcys/eGFRcr ratio and SGHS (defined as eGFRcys/eGFRcr <0.7).
Main Results:
- A declining eGFRcys/eGFRcr ratio was observed across glycemic categories (normoglycemia, prediabetes, diabetes).
- SGHS prevalence increased stepwise with worsening glycemic control.
- Higher HbA1c, fasting glucose, and HOMA-IR were independently associated with a lower eGFRcys/eGFRcr ratio and increased SGHS prevalence.
Conclusions:
- Dysglycemia and insulin resistance are associated with a lower eGFRcys/eGFRcr ratio and higher SGHS prevalence.
- These findings suggest potential kidney vulnerability or altered biomarker metabolism in individuals with dysglycemia and insulin resistance.
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