Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study

Abstract

Introduction Renal hyperfiltration (RHF) has been found to be an independent predictor of adverse cardiovascular outcome. However, it remains uncertain whether it is precursor of chronic kidney disease (CKD) in a healthy population. Materials and methods To determine relative risks and identify the predictor of incident proteinuria and decline of estimated glomerular filtration rate (eGFR) in subjects with RHF. A total of 55,992 subjects aged �20 years who underwent health checkup during 2004-2017 were included. Among them, 16,946 subjects who completed at least two health checkups were analyzed. Results A total of 949 (5.6%) subjects developed proteinuria and 98 (0.6%) subjects showed � 30% of eGFR decline. The risk of incident proteinuria was significantly higher in those with RHF (RR: 1.644; 95% CI: 1.064-2.541). Those with RHF showed 8.720 fold (95% CI: 4.205-18.081) increased risk for �30% decline. ESR, CRP, and monocyte count showed reversed J shaped curve according to the increase of eGFR. The adjusted mean of monocyte count was significantly higher in participants with eGFR �90ml/min/1.73m 2 or < 60ml/min/1.73m 2 compared to that in patients with eGFR 75-89ml/min/1.73m 2. Compared to subjects with the lowest tertile of monocyte and no RHF, those with the highest tertile of monocyte count in the RHF group had 3.314-fold (95% CI: 1.893-5.802) higher risk of incident proteinuria and 3.822-fold (95% CI, 1.327-11.006) risk of 30% eGFR decline. Conclusions RHF had significantly increased risk of developing proteinuria and CKD in healthy subjects. Higher monocyte count might be used as a predictor of CKD in subjects with RHF.

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

“…Indeed, large observational studies concluded that, even in health, the presence of hyperfiltration signifies further eGFR decline and risk of CKD development [ 31 , 32 ]. The Japanese study revealed that basic eGFR values in people with hyperfiltration were significantly higher (although within normal range) than in those who did not develop hyperfiltration [ 31 ].…”

“…Then, the eGFR decline followed, and it was accelerated in patients with hyperfiltration when compared with those without it [ 31 ]. The Korean experience proved that hyperfiltration was connected with the increased risk of incident proteinuria and 30% eGFR decline [ 32 ]. The authors concluded that hyperfiltration may be treated as an indicator of increased risk of developing CKD in an apparently healthy population.…”

Update on Pathogenesis of Glomerular Hyperfiltration in Early Diabetic Kidney Disease

“…One challenge to overcome is the difficulty of diagnosing DKD in its initial stages. Glomerular hyperfiltration usually occurs in an early stage of renal damage before the appearance of proteinuria ( 3 , 4 ), without clinical manifestations. It is considered to be a risk factor for DKD ( 5 ).…”

Vaptans or voluntary increased hydration to protect the kidney: how do they compare?

“…Glomerular hyperfiltration is known to be associated with further kidney dysfunction, adverse cardiovascular events and/or death [11][12][13][14][15][16][17]. Experimental studies and clinical investigations have shown that the sustained action of the selective V2R agonist dDAVP induces a chronic hyperfiltration and a rise in urinary albumin excretion [18,19] while the suppression of AVP secretion by a water load results in a decrease in GFR [18,20,21].…”