Long-term prospective observation suggests that glomerular hyperfiltration is associated with rapid decline in renal filtration function: A multiethnic study. (September 2018)

• Record Type: Journal Article
• Authors: Low, Serena; Zhang, Xiao; Wang, Jiexun; Yeoh, Lee Ying; Liu, Yan Lun; Ang, Keven Kue Loong; Tang, Wern Ee; Kwan, Pek Yee; Tavintharan, Subramaniam; Sum, Chee Fang; Lim, Su Chi
• Is Part Of: Diabetes & vascular disease research. Volume 15:Number 5(2018:Sep.)
• Page Start: 417
• Page End: 423
• Publication Date: 2018-09
• Subjects: Type 2 diabetes mellitus -- glomerular filtration rate -- hyperfiltration -- rapid renal decline; Diabetic angiopathies -- Periodicals; 616.462005
• DOI: 10.1177/1479164118776465
• Languages: English
• ISSNs: 1479-1641

Abstract

Aim: Glomerular hyperfiltration usually occurs early in development of kidney complications in diabetes. To understand hyperfiltration as a marker of renal disease progression in type 2 diabetes mellitus, we aimed to examine association between glomerular hyperfiltration (estimated glomerular filtration rate ⩾ 120 mL/min/1.73 m 2 ) and rapid renal decline (annual estimated glomerular filtration rate loss ⩾ 3 mL/min/1.73 m 2 ). Methods: This was a prospective cohort comprising 1014 patients with type 2 diabetes mellitus attending a Diabetes Centre of a regional hospital in 2002–2014. A separate prospective cohort, comprising 491 patients who attended Diabetes Centre or primary-care polyclinics, was used for validation. We performed binary mediation analysis to examine role of hyperfiltration on relationship between baseline haemoglobin A1c and rapid renal decline. Results: Among patients in discovery cohort, 5.2% had baseline hyperfiltration. Over mean follow-up of 6 years, 22.9% had rapid glomerular filtration rate decline. Baseline hyperfiltration was significantly associated with greater odds of rapid renal decline after adjusting for demographics, diabetes duration and clinical covariates (odds ratio: 2.57; 95% confidence interval: 1.21–5.46; p = 0.014). Similar finding was found in validation cohort (odds ratio: 2.98; 95% confidence interval: 1.06–8.42; p = 0.034). Hyperfiltration significantly accounted for 35.3% of association between increasing baseline haemoglobin A1c and rapid renal decline. Conclusion: Glomerular hyperfiltration is an independent risk factor of rapid renal decline. It mediates the association between increasing haemoglobin A1c and rapid renal decline.