Prediabetes is associated with glomerular hyperfiltration in a European Mediterranean cohort study
Glomerular hyperfiltration is well recognized as an early renal alteration in subjects with diabetes mellitus. However, what is not well-known is whether hyperfiltration also occurs in the early stages of hyperglycaemia, for instance in prediabetes. Identifying subjects with glomerular hyperfiltration from among those with prediabetes might be helpful to implement preventive and therapeutic strategies. This study aimed to investigate the association of prediabetes with glomerular hyperfiltration and its associated variables.
A representative sample of 9238 people aged ≥ 30 years and whose entire clinical and laboratory data were available, were included in this study. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation.
After adjustment for age, gender, body mass index, systolic blood pressure and diastolic blood pressure, cholesterol, log (triglycerides), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum uric acid, smoking status, hypertension, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, fasting plasma glucose (FPG) was found to be independently positively associated with eGFR. The hazard ratios (95% confidence interval) for hyperfiltration were 1.61 (1.28–2.03) and 2.30 (1.89–2.79) for prediabetes and diabetes, respectively, when compared with participants with normoglycemia.
Prediabetes was associated with glomerular hyperfiltration. Longitudinal studies are needed to investigate whether hyperfiltration in prediabetes is associated with a later decline in eGFR.
KeywordsPrediabetes Impaired fasting glucose Glomerular hyperfiltration Chronic kidney disease Retrospective poblational cohort
We appreciate the comments of the editor and of anonymous reviewers of a previous version of this work who, without doubt, helped us to improve our work.
ARP had the original idea of the paper. GCT and MS designed the study. The bibliographic search and the writing of the introduction were made by ARP and GCT. The choice of methods and statistical analysis was performed by JB and MC. JB, MC and ARP built the tables and figures. All authors (ARP, JB, MC, MS, MAB, GCT) wrote the results and the discussion. The writing and final editing was done by JB, ARP and MAB. All authors reviewed and approved the manuscript.
This work was partly funded by the research project PI15/00140 from FIS, ‘Instituto de Salud Carlos III’, ISCIII, Spanish Ministry of Economy and Competitiveness and by the projects ‘Grant to improve the scientific productivity of the research groups of the University of Girona 2016–2018’ (MPCUdG2016) and GDRCompetUdG2017. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Conflict of interest
The authors have declared that no conflict of interest exists. All authors will disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations that could inappropriately influence or be perceived to influence their work, within 3 years of beginning the submitted work.
The data for this study came from an anonymised clinical administrative database and only the lead researcher, where necessary, had access to the identity of each individual. This study has also been revised and approved by the Ethics and Clinical Research Committee (CEIC) of the Institute of Health Care (IAS), Girona, Spain).
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