{"id":"af8ddedf3661","type":"article","url":"https://hartvaat.nl/2026/07/31/verhoogde-serumketonen-verlagen-niercomplicaties-bij-type-2-diabetes-prospectief/","title":"Verhoogde serumketonen verlagen niercomplicaties bij type 2-diabetes — prospectief cohort","title_en":"Serum ketone body levels and risk of incident kidney and cardiovascular events among patients with type 2 diabetes: a prospective cohort study.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Diabetes research and clinical practice","doi":"10.1016/j.diabres.2026.113476","source_url":"https://doi.org/10.1016/j.diabres.2026.113476","authors":["Soo Myoung Shin","Jiyoon Lee","Young-Eun Kim","Jung A Kim","Kyoung Jin Kim","Kyeong Jin Kim","Hee Young Kim","Sin Gon Kim","Nam Hoon Kim"],"significance":4,"published":"2026-08-14","source_date":"2026-07-31","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"A prospective cohort study of 1,392 stable patients with type 2 diabetes found that mildly elevated serum ketone levels were independently associated with a reduced risk of kidney complications. Over a median follow-up of 23.2 months, participants in the highest ketone tertile had a 54% lower risk of a ≥40% decline in eGFR (adjusted HR 0.46) and a 37% lower risk of a composite kidney outcome (aHR 0.63) compared to the lowest tertile, with similar non-significant trends for cardiovascular events. While these findings highlight ketones as a potential biomarker for renal risk, they do not yet translate into specific clinical interventions.","created":"2026-08-07T01:36:24Z","updated":"2026-08-10T10:35:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een prospectief cohortonderzoek bij 1392 stabiele patiënten met type 2-diabetes toont aan dat licht verhoogde serumketonspiegels onafhankelijk geassocieerd zijn met een lager risico op niercomplicaties. Na een mediane follow-up van 23,2 maanden hadden patiënten in de hoogste tertiel een 54% lager risico op een eGFR-daling van ≥40% (aHR 0,46) en een 37% lager risico op een samengestelde nieruitkomst (aHR 0,63) vergeleken met de laagste tertiel. Cardiovasculaire uitkomsten liepen in dezelfde, niet-significante, richting. Deze bevindingen suggereren dat ketonspiegels een rol kunnen spelen als biomarker voor nierrisico, maar bevestigen nog geen directe therapeutische stappen.","abstract_original":"AIM: To evaluate the associations between serum ketone body levels and kidney and cardiovascular outcomes in patients with type 2 diabetes. METHODS: This prospective cohort analysis included 1392 clinically stable patients with type 2 diabetes who were not receiving insulin or thiazolidinedione therapy. Serum total ketone body concentrations were measured under stable outpatient conditions and categorized into tertiles: 0.08-92.3, 92.7-170.8, and 171.0-1629.6 µmol/L. Kidney outcomes included new-onset macroalbuminuria, ≥40% decline in eGFR and end-stage kidney disease. Cardiovascular outcomes included myocardial infarction, revascularization, ischemic stroke, hospitalization for heart failure, and cardiovascular death. RESULTS: During a median 23.2-month follow-up, 158 kidney and 64 cardiovascular events occurred. Compared with the lowest ketone body tertile, the highest ketone body tertile was associated with lower risk of ≥40% eGFR decline (adjusted HR [aHR], 0.46; 95%CI 0.26-0.84) and composite kidney outcomes (aHR 0.63; 95%CI, 0.41-0.98). Among participants with baseline eGFR ≥ 60 mL/min/1.73 m2, incident chronic kidney disease was also reduced (aHR 0.50; 95%CI 0.31-0.79). Cardiovascular outcomes showed favorable but non-significant trends. CONCLUSION: Mildly elevated serum ketone body levels were independently associated with lower adverse kidney outcomes in patients with type 2 diabetes, supporting their potential role as mediators of kidney risk."}