# Cystatine C voorspelt hart- en nierrisico beter dan creatinine bij diabetes type 2 — DECLARE-TIMI 58

*geplaatst 2026-11-04 · Hartfalen · American heart journal plus : cardiology research and practice · doi 10.1016/j.ahjo.2026.100929 · https://hartvaat.nl/2026/11/01/cystatine-c-voorspelt-hart-en-nierrisico-beter-dan-creatinine-bij-diabetes-type-/*

In een nested analyse van de DECLARE-TIMI 58-studie bleek cystatine C een sterker risicogradient te geven voor cardiovasculaire en niercomplicaties dan creatinine bij patiënten met diabetes type 2 en een behouden nierfunctie. Patiënten in het hoogste quartiel hadden een 33% hoger risico op hartfalenhospitalisatie of cardiovasculaire dood (HR 1,33; p-trend 0,016) vergeleken met het laagste quartiel, terwijl creatinine geen significante gradient toonde. Het preventieve effect van dapagliflozin bleek onafhankelijk van de baselijn-cystatine C-waarde, wat ondersteunt dat deze SGLT2-remmer breed inzetbaar blijft in deze patiëntengroep.

## English: Comparative risk assessment of cardiovascular and kidney outcomes in patients with type 2 diabetes using cystatin C and creatinine in DECLARE-TIMI 58.

In a nested biomarker analysis of the DECLARE-TIMI 58 trial, cystatin C demonstrated a stronger risk gradient for cardiovascular and kidney outcomes than creatinine in patients with type 2 diabetes and preserved kidney function. Patients in the highest quartile had a 33% higher risk of cardiovascular death or heart failure hospitalization (HR 1.33; p-trend 0.016) compared with the lowest quartile, whereas creatinine-based stratification showed no significant gradient. The cardiovascular and renal benefit of dapagliflozin was consistent regardless of baseline cystatin C levels, supporting its broad use in this population.

## Abstract (original, from the publication)

BACKGROUND: The relationship between cystatin C and cardiovascular and kidney outcomes is not well explored in individuals with type 2 diabetes (T2D) and normal or mild kidney dysfunction. METHODS: This nested prospective biomarker study included patients enrolled in DECLARE-TIMI 58. Participants were categorized into quartiles of CysC/creatinine and eGFRCysC/eGFRCr and classified according to Kidney Disease Improving Global Outcomes (KDIGO) risk categories. Hazard ratios were estimated for a composite of cardiovascular death and hospitalization for heart failure (CVD/HHF), major adverse cardiovascular events (MACE), and a kidney-specific composite outcome (persistent ≥40% decrease in eGFR, end-stage renal disease, or renal death). RESULTS: Among 1899 placebo-treated patients, higher baseline CysC was associated with higher risk for CVD/HHF, MACE, and the kidney-specific composite outcome. A gradient of risk across quartiles was observed for CVD/HHF [Q4 v Q1: 1.33 (0.98-1.80), p-trend = 0.016]; MACE [1.34 (1.06-1.69), p-trend = 0.013]; and kidney-specific composite outcome [1.95 (0.95-3.99), p-trend = 0.036]. When compared with creatinine, CysC showed more pronounced and statistically significant risk gradients (CVD/HHF: KDIGO-CysC p-trend < 0.001 vs. p-trend Cr 0.34; MACE: CysC p-trend < 0.001 vs. Cr p-trend 0.52). No heterogeneity was observed in the effect of dapagliflozin across CysC concentrations (p-interactions >0.05). CONCLUSION: In patients with T2D and predominantly preserved Cr-based eGFR, CysC was associated with increased cardiovascular and kidney risk. Although discrimination assessed by c-statistic was similar for CysC and Cr, risk gradients seen with CysC became attenuated and no longer statistically significant when using Cr-based analogs. The effect of dapagliflozin was consistent irrespective of baseline CysC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730534.

Auteurs: Andre M Small, David D Berg, Itamar Raz, Petr Jarolim, Erica L Goodrich, Filipe A Moura, Ofri Mosenzon, Avivit Cahn, Deepak L Bhatt, Jamie P Dwyer, Lawrence A Leiter, John P H Wilding, Ingrid Gause-Nilsson, Marc S Sabatine, David A Morrow, Stephen D Wiviott

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Bron: American heart journal plus : cardiology research and practice, https://doi.org/10.1016/j.ahjo.2026.100929. Bijgewerkt 2026-10-28T02:41:32Z. 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.