Selective glomerular hypofiltration syndrome (SGHS), defined by an eGFRcys/eGFRcr ratio <0.60, is independently associated with cardiovascular disease prevalence and independently predicts adverse renal outcomes in patients with biopsy-proven diabetic kidney disease.
SGHS was present in 22.5% of patients with biopsy-proven diabetic kidney disease.
The eGFRcys/eGFRcr ratio outperformed other kidney function markers in predicting cardiovascular disease prevalence at the time of DKD diagnosis.
SGHS was independently associated with cardiovascular disease prevalence after multivariable adjustment.
A nomogram incorporating SGHS demonstrated good discrimination and calibration for predicting CVD prevalence in DKD patients.
Patients with SGHS had significantly higher cumulative DKD progression probability over follow-up.
This research suggests that a simple ratio comparing two different ways of estimating kidney filtration rate—one using a protein called cystatin C and one using creatinine—can identify a group of diabetic kidney disease patients at much higher risk for heart disease and worsening kidney function. When the cystatin C-based estimate is disproportionately low compared to the creatinine-based estimate (a ratio below 0.60), the researchers call this 'selective glomerular hypofiltration syndrome' (SGHS). Among 182 patients whose kidney disease was confirmed by biopsy, about 1 in 4 had this pattern, and those patients were over 9 times more likely to already have cardiovascular disease at the time of their diagnosis. Over a follow-up period averaging about 2.5 years, patients with SGHS were also more than twice as likely to experience worsening of their kidney disease compared to those without SGHS. Importantly, the eGFRcys/eGFRcr ratio was better at predicting cardiovascular disease than any of the individual kidney function measures (creatinine-based eGFR, cystatin C-based eGFR, a combined estimate, or urine albumin levels) used alone. These findings were consistent across different patient subgroups defined by sex and body weight, and held up when the researchers tested a slightly different definition of SGHS. This research suggests that calculating this simple ratio—using two measures that are already commonly obtained in clinical practice—could serve as a valuable, low-cost tool to identify diabetic kidney disease patients who need more intensive monitoring or management for both kidney and cardiovascular complications. The findings highlight that how kidney function is measured matters, and that the discrepancy between different measurement methods itself carries important clinical information.
Fang Y, Guo X, Zhong L, He X, Zhang X, Wan J. (2026). Selective glomerular hypofiltration syndrome: a novel renal phenotype associated with cardiovascular disease and adverse outcomes in diabetic kidney disease.. BMJ open diabetes research & care. https://doi.org/10.1136/bmjdrc-2026-006417