Renal hyperfiltration is independently associated with increased all-cause mortality in individuals with type 2 diabetes: a prospective cohort study
Open Access
- 14 July 2020
- journal article
- research article
- Published by BMJ in BMJ Open Diabetes Research & Care
- Vol. 8 (1), e001481
- https://doi.org/10.1136/bmjdrc-2020-001481
Abstract
Introduction In addition to favoring renal disease progression, renal ‘hyperfiltration’ has been associated with an increased risk of death, though it is unclear whether and how excess mortality is related to increased renal function. We investigated whether renal hyperfiltration is an independent predictor of death in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events Italian multicenter study. Research design and methods This observational, prospective cohort study enrolled 15 773 patients with type 2 diabetes consecutively attending 19 Italian diabetes clinics in 2006–2008. Serum creatinine, albuminuria, cardiovascular risk factors, and complications/comorbidities were assessed at baseline. Vital status on 31 October 2015 was retrieved for 15 656 patients (99.26%). Patients were stratified (A) by absolute estimated glomerular filtration rate (eGFR) values in eGFR deciles or Kidney Disease: Improving Global Outcomes (KDIGO) categories and (B) based on age-corrected thresholds or age and gender-specific 95th and 5th percentiles in hyperfiltration, hypofiltration, and normofiltration groups. Results The highest eGFR decile/category and the hyperfiltration group included (partly) different individuals with similar clinical features. Age and gender-adjusted death rates were significantly higher in deciles 1, 9, and 10 (≥103.9, 50.9–62.7, and 2, respectively) versus the reference decile 3 (92.9–97.5 mL/min/1.73 m2). Mortality risk, adjusted for multiple confounders, was also increased in deciles 1 (HR 1.461 (95% CI 1.175 to 1.818), p=0.001), 9 (1.312 (95% CI 1.107 to 1.555), p=0.002), and 10 (1.976 (95% CI 1.673 to 2.333), pConclusions In type 2 diabetes, both high-normal eGFR and hyperfiltration are associated with an increased risk of death from any cause, independent of confounders that may directly impact on mortality and/or affect GFR estimation. Further studies are required to clarify the nature of this relationship. Trial registration number NCT00715481.Keywords
Funding Information
- Diabete Ricerca (N/A)
- Eli Lilly and Company (N/A)
- Boehringer Ingelheim (N/A)
- Takeda Pharmaceutical Company (N/A)
- Sigma-Tau Pharmaceuticals (N/A)
- Diabetes, Endocrinology and Metabolism Foundation (N/A)
- Chiesi Farmaceutici (N/A)
This publication has 51 references indexed in Scilit:
- Age and Association of Kidney Measures With Mortality and End-stage Renal DiseaseJAMA, 2012
- Normal reference values for glomerular filtration rate: what do we really know?Nephrology Dialysis Transplantation, 2012
- Glomerular hyperfiltration: definitions, mechanisms and clinical implicationsNature Reviews Nephrology, 2012
- Diverging Association of Reduced Glomerular Filtration Rate and Albuminuria With Coronary and Noncoronary Events in Patients With Type 2 DiabetesDiabetes Care, 2011
- Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific DeathThe New England Journal of Medicine, 2011
- Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort studyBMJ, 2010
- Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysisThe Lancet, 2010
- Method of Glomerular Filtration Rate Estimation Affects Prediction of Mortality RiskJournal of the American Society of Nephrology, 2009
- The Presence and Severity of Chronic Kidney Disease Predicts All-Cause Mortality in Type 1 DiabetesDiabetes, 2009
- Glomerular hyperfiltration: A new marker of metabolic riskKidney International, 2007