Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: The HARVEST

Palatini, Paolo; Mormino, Paolo; Dorigatti, Francesca; Santonastaso, Massimo; Mos, Lucio; Toni, Renzo De; Winnicki, Mikołaj; Follo, Marta Dal; Biasion, T.; Garavelli, G.; Pessina, Achille C.

doi:10.1038/sj.ki.5001603

Cited by 89 publications

(81 citation statements)

References 35 publications

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“…To account for the age-related decline in GFR, hyperfiltration was defined as GFR >130 ml min −1 1.73 m −2 minus 1 ml min −1 1.73 m −2 per year after the age of 40 [28]. Studies in hypertensive non-diabetic participants, using creatinine clearance as an index of GFR, have suggested that elevated GFR may be an indicator of early target organ damage [37,38]. In the PREVEND (Prevention of Renal and Vascular Disease) study, a community based study in 7,728 non-diabetic participants, GFR estimated by creatinine clearance was proportional to BMI [39] and elevated AER was independently associated with hyperfiltration assessed by creatinine clearance [40].…”

Section: Hyperfiltration Independent Of Diabetesmentioning

confidence: 99%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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Glomerular filtration rate is commonly elevated in early diabetes and patients with this symptom are arbitrarily considered to have hyperfiltration. The prevalence of hyperfiltration in type 1 diabetes varies from less than 25% to more than 75%. The corresponding figures in type 2 diabetes are significantly lower, ranging between 0% and more than 40%. Several factors, methodological and biological, may contribute to the wide variation in estimates of hyperfiltration prevalence. Methodological differences in measurement and evaluation of GFR apply in particular to the handling of plasma disappearance curves of filtration markers. Biological factors that may influence GFR in the hyperfiltration range include glycaemic control, diabetes duration, BMI, sex, pubertal status in type 1 diabetes and age in type 2 diabetes. Hyperglycaemia may influence GFR and albuminuria, and may therefore confound the evaluation of hyperfiltration as an independent risk factor for diabetic nephropathy. Adequate assessment of the relationship between glycaemic control, GFR and AER therefore requires serial measurements of all three variables followed by multivariate analysis. A recent meta-analysis of ten type 1 diabetes studies concluded that the presence of hyperfiltration at baseline more than doubled the risk of developing micro-or macroalbuminuria at follow-up. However, not all studies allowed for confounding factors or regression dilution bias. Future studies will therefore need to address the independent role of hyperfiltration, not only in the evolution of albuminuria, but also in the subsequent decline of GFR.

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Section: Hyperfiltration Independent Of Diabetesmentioning

confidence: 99%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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“…These cutoffs have been used previously to categorize CKD (5,20), and to define hyperfiltration (21).…”

Section: Evaluation Of the Estimated Gfrmentioning

confidence: 99%

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Sharma

Yasin

Garg

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The diagnostic accuracy of cystatin C estimated GFR (eGFR) by various cystatin C equations have varied in different studies. We hypothesized that the GFR level of enrolled patients affects the diagnostic accuracy of a cystatin C equation.Design, setting, participants, & measurements We analyzed 240 consecutively enrolled children at a single Canadian center in a prospective and cross-sectional study. Cystatin C was analyzed with nephelometry, and cystatin C eGFR was estimated by the equations validated in children. GFR was measured by technetium-99m-diethylene-triamine penta-acetic acid ( 99m Tc DTPA).Results We compared various cystatin C equations across GFR strata Ͻ60, Ͻ90, Ն135, and Ն150 ml/min per 1.73 m 2 for an accurate prediction and appropriate classification of the measured GFR. The CKiD, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a higher accuracy, estimated by eGFR values within 10% and 30% of the respective 99m Tc DTPA, in the GFR categories Ͻ60 and Ͻ90 ml/min per 1.73 m 2 , whereas the Bö kenkamp, Bouvet, and Filler equations had a greater accuracy in the GFR categories Ն135 and Ն150 ml/min per 1.73 m 2 . The Bouvet, CKiD, Filler, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a greater sensitivity to classify GFR Ͻ60 and Ͻ90 ml/min per 1.73 m 2 , whereas the Bö kenkamp equation had a higher sensitivity for GFR Ն135 and Ն150 ml/min per 1.73 m 2 . ConclusionsThe diagnostic accuracy of various cystatin C equations varies with GFR. This issue needs consideration while applying these equations in clinical practice and for further research on eGFR equations.

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“…In the general population, the systolic blood pressure and fasting glucose appear to be the most important factors related to MAB, through their direct effect on the glomerular intra-renal pressure or the stimulation of the renin-angiotensin-aldosterone system [19]. Inflammation, endothelial dysfunction and thrombogenic factors have been implicated as potential mechanisms underlying the relationship between proteinuria and cardiovascular disease [20].…”

Section: @Erspublicationsmentioning

confidence: 99%

Microalbuminuria as a potential novel cardiovascular biomarker in patients with COPD

Casanova¹,

Celli

2014

Eur Respir J

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@ERSpublicationsMicroalbuminuria is a simple biomarker that identifies COPD patients at increased cardiovascular risk http://ow.ly/tdIAB Chronic obstructive pulmonary disease (COPD) is now recognised as the third cause of death in the world [1]. Patients with COPD are more likely to have pre-existing cardiovascular disease (CVD) and are at high risk of acute events, hospitalisations and death from CVD [2,3]. Furthermore, this strong association is independent of the degree of airflow limitation. Because of this, the Global Initiative for Chronic Obstructive Lung Disease initiative recognises CVD as the most important disease coexisting with COPD and suggests it should be routinely looked for, but makes no recommendation on how to do it [4].Over the past two decades, interest in CVD prevention has expanded and now promotes not only primary prevention, but also identification of factors that could help clarify CVD pathophysiology, offer targets for intervention or lead to improved risk stratification beyond that allowed by the Framingham equations [5]. Currently, only a few biomarkers have been accepted as being clinically useful [6]. In this regard, the recent consensus of the American College of Cardiology/American Heart Association recognises family history as being useful and haemoglobin A1c measurement as reasonable in all adults. They also categorise microalbuminuria (MAB) assessment as reasonable in adults with hypertension or diabetes [7].The discovery of novel ''biomarkers'' that could help identify cardiovascular risk in patients with COPD could help personalise therapy for that particular phenotype. To be clinically useful, the biomarker should be inexpensive, noninvasive and easily measurable. Therefore, MAB could be a promising biomarker to identify patients with COPD at increased risk for poor cardiovascular outcomes. The presence of MAB is consistently associated with arterial stiffness assessed by pulse wave velocity and worse cardiovascular outcomes in patients with diabetes, hypertension and, importantly, in the general population [8][9][10]. MAB has been shown to have a stronger association with cardiovascular events and death than C-reactive protein [11], and is thought to reflect a state of generalised endothelial dysfunction.The limited number of studies that have investigated the presence of MAB in patients with COPD have reported a high prevalence in patients during acute exacerbations [12][13][14] and, importantly, also in stable state [15,16]. Several authors have shown that after adjusting for smoking and independent of the presence of diabetes and hypertension, the prevalence is ,25% of patients with stable COPD [15,16].In this issue of European Respiratory Journal (ERJ), ROMUNDSTAD et al. [17] confirm this data in a large population-based study. A total of 3129 subjects, aged o20 years, with spirometry and morning urine

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Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: The HARVEST

Cited by 89 publications

References 35 publications

The clinical significance of hyperfiltration in diabetes

The clinical significance of hyperfiltration in diabetes

Diagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

Microalbuminuria as a potential novel cardiovascular biomarker in patients with COPD

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