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Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study.
Am J Kidney Dis 2016; 67(6):841-50AJ

Abstract

BACKGROUND

The role of prediabetes as a risk factor for hyperfiltration and albuminuria in persons who do not develop diabetes is unclear. The lack of evidence is mainly due to the difficulty of accurately assessing the glomerular filtration rate (GFR) in the near-normal range of GFR. We investigated whether prediabetes is an independent risk factor for glomerular hyperfiltration and high-normal urinary albumin-creatinine ratio (ACR) using measured GFR (mGFR) rather than estimated GFR.

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 (>10mg/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.

Authors+Show Affiliations

Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway. Electronic address: toralf.melsom@unn.no.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Oslo University Hospital, Oslo, Norway.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26744126

Citation

Melsom, Toralf, et al. "Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: a Prospective Cohort Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 67, no. 6, 2016, pp. 841-50.
Melsom T, Schei J, Stefansson VT, et al. Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study. Am J Kidney Dis. 2016;67(6):841-50.
Melsom, T., Schei, J., Stefansson, V. T., Solbu, M. D., Jenssen, T. G., Mathisen, U. D., ... Eriksen, B. O. (2016). Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 67(6), pp. 841-50. doi:10.1053/j.ajkd.2015.10.025.
Melsom T, et al. Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: a Prospective Cohort Study. Am J Kidney Dis. 2016;67(6):841-50. PubMed PMID: 26744126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study. AU - Melsom,Toralf, AU - Schei,Jørgen, AU - Stefansson,Vidar Tor Nyborg, AU - Solbu,Marit Dahl, AU - Jenssen,Trond Geir, AU - Mathisen,Ulla Dorte, AU - Wilsgaard,Tom, AU - Eriksen,Bjørn Odvar, Y1 - 2015/12/29/ PY - 2015/07/01/received PY - 2015/10/20/accepted PY - 2016/1/9/entrez PY - 2016/1/9/pubmed PY - 2017/6/1/medline KW - HbA(1c) KW - Prediabetes KW - Tromsø study KW - albumin-creatinine ratio (ACR) KW - albuminuria KW - chronic hyperglycemia KW - estimated GFR KW - fasting glucose KW - glomerular filtration rate (GFR) KW - hyperfiltration KW - iohexol clearance KW - measured GFR KW - modifiable risk factor KW - renal disease SP - 841 EP - 50 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 67 IS - 6 N2 - BACKGROUND: The role of prediabetes as a risk factor for hyperfiltration and albuminuria in persons who do not develop diabetes is unclear. The lack of evidence is mainly due to the difficulty of accurately assessing the glomerular filtration rate (GFR) in the near-normal range of GFR. We investigated whether prediabetes is an independent risk factor for glomerular hyperfiltration and high-normal urinary albumin-creatinine ratio (ACR) using measured GFR (mGFR) rather than estimated GFR. 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 (>10mg/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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26744126/Prediabetes_and_Risk_of_Glomerular_Hyperfiltration_and_Albuminuria_in_the_General_Nondiabetic_Population:_A_Prospective_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)01389-X DB - PRIME DP - Unbound Medicine ER -