Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study
AuthorMelsom, Toralf; Schei, Jørgen; Stefansson, Vidar Tor Nyborg; Solbu, Marit Dahl; Jenssen, Trond Geir; Mathisen, Ulla Dorte; Wilsgaard, Tom; Eriksen, Bjørn Odvar
Study Design: Prospective cohort study based on the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6) and the RENIS Follow-Up Study. Median observation time was 5.6 years.
Setting & Participants: A representative sample of 1,261 persons without diabetes mellitus (DM) from the general population aged 50 to 62 years.
Predictor: Prediabetes defined by fasting glucose and hemoglobin A1c according to levels suggested by the American Diabetes Association (preDMADA) and the International Expert Committee of 2009 (preDMIEC).
Outcomes: Change in mGFR; hyperfiltration defined as mGFR . 90th percentile adjusted for age, sex, weight, and height; and high-normal ACR (.10 mg/g) at follow-up.
Measurements: GFR was measured with iohexol clearance.
Results: Baseline fasting glucose, hemoglobin A1c, and both definitions of prediabetes were predictors of higher mGFR at follow-up and lower annual mGFR decline in multivariable-adjusted regression analyses. Participants with preDMIEC had an OR for hyperfiltration of 1.95 (95% CI, 1.20-3.17) and for high-normal ACR of 1.83 (95% CI, 1.04-3.22) at follow-up. We adjusted for cardiovascular risk factors including ambulatory blood pressure at baseline and change in use of antihypertensive medication between baseline and follow-up.
Limitations: Only middle-aged white patients participated. There is no consensus on how to define glomerular hyperfiltration.
Conclusions: Our findings imply an independent role of prediabetes in the development of glomerular hyperfiltration and albuminuria. Prediabetes might be a target for early treatment to prevent chronic kidney disease in chronic hyperglycemia.
Accepted manuscript version. Published version available at http://dx.doi.org/10.1053/j.ajkd.2015.10.025