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A low eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio (&lt;0.60), reflecting a pathological glomerular state termed shrunken pore syndrome (SPS), has been associated with excess mortality in some clinical situations including diabetes. The aim of the present study was to explore this association in a longitudinal observational study of type 2 diabetes with special reference to participants with normal renal function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Of 1481 Fremantle Diabetes Study Phase II participants with type 2 diabetes, aged \u226517 years, 1466 had eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      and eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      assessed as part of the baseline assessment and were followed for 10 years or until death, whichever came first. Cox regression modelling was used to determine independent associates of death excluding eGFR; eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio was then added to this model separately as a categorical or continuous variable. These analyses were also conducted in a subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      =754) of participants with normal renal function (eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      \u226560 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      and urinary albumin\/creatinine ratio &lt;3 mg\/mmol) at baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At entry, the participants had a mean age of 65.9 years, 51.8% were male, the median diabetes duration was 9.0 years and 10.4% had eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio &lt;0.60 (the definition of SPS). There were 384 deaths (26.2%) during follow-up. The eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio was independently, significantly and negatively associated with death (adjusted HR [95% CI] 0.91 [0.85, 0.97] for an increase of 0.1,\n                      <jats:italic>p<\/jats:italic>\n                      =0.004). Of eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio categories, only &lt;0.60 added significantly to the most parsimonious Cox model of time to death (HR [95% CI] 1.56 [1.07, 2.29],\n                      <jats:italic>p<\/jats:italic>\n                      =0.021). In those with normal renal function, 123 (16.3%) died during follow-up. An eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio &lt;0.60, observed in 57 (7.6%), was also independently associated with mortality (HR [95% CI] 2.55 [1.34, 4.84],\n                      <jats:italic>p<\/jats:italic>\n                      =0.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>\n                      A low eGFR\n                      <jats:sub>cyst<\/jats:sub>\n                      \/eGFR\n                      <jats:sub>creat<\/jats:sub>\n                      ratio is independently associated with mortality in type 2 diabetes, including in people without conventional markers of diabetic kidney disease. The presence of SPS may add clinical value to the risk assessment of people with type 2 diabetes regardless of renal status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-025-06430-6","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T10:56:51Z","timestamp":1745233011000},"page":"1440-1451","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The relationship between shrunken pore syndrome and all-cause mortality in people with type 2 diabetes and normal renal function: the Fremantle Diabetes Study Phase II"],"prefix":"10.1007","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9979-6867","authenticated-orcid":false,"given":"David G.","family":"Bruce","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5709-8235","authenticated-orcid":false,"given":"Wendy A.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6742-4110","authenticated-orcid":false,"given":"S. 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The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"Open Access funding enabled and organized by CAUL and its Member Institutions. The present study was funded by the National Health and Medical Research Council of Australia (project grants 513781 and 1042231), which had no involvement in the study design, data collection, analysis and interpretation of results or writing this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"DGB conceived the present FDS2 sub-study and wrote the initial manuscript. WAD performed statistical analyses and reviewed\/edited the manuscript. SAPC supervised biochemical analyses and reviewed\/edited the manuscript. TMED co-ordinated all data collection, contributed to the sub-study design and data interpretation, and produced the final version of the manuscript. TMED as guarantor accepts full responsibility for the work and\/or the conduct of the study, had access to the data, and controlled the decision to publish.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}