The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study

Amin, Rakesh; Turner, Charles; Aken, Sara Van; Bahu, T Konopelska; Watts, Angela; Lindsell, D. R. M.; Dalton, R. Neil; Dunger, David B.

doi:10.1111/j.1523-1755.2005.00590.x

Cited by 134 publications

(114 citation statements)

References 48 publications

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“…However, the prevalence of hyperfiltration in other studies in type 1 diabetes has varied from as low as 13% [16] to as high as 67% [17]. Apart from hyperglycaemia, other factors influencing the prevalence of hyperfiltration in type 1 diabetes include the level of albuminuria, duration of diabetes, younger age of disease onset and pubertal status [11].…”

Section: Prevalence Of Hyperfiltration In Type 1 Diabetesmentioning

confidence: 96%

“…However, hyperfiltration has been traditionally defined as GFR >2 standard deviations above the mean GFR in control participants. The threshold for hyperfiltration has ranged from 125 to 140 ml min −1 1.73 m −2 in various studies [9,11,12].…”

Section: Measurement Of Gfrmentioning

confidence: 99%

“…Hyperfiltration is arbitrarily defined as being present when whole-kidney GFR exceeds 125 to 140 ml min −1 1.73 m −2 in an individual with two functioning kidneys [9,11,12]. In early diabetes, hyperfiltration at the whole-kidney level may reflect a generalised increase in single-nephron GFR, but a contribution by increased nephron endowment cannot be ruled out.…”

Section: Hyperfiltration At Whole-kidney and Single-nephron Levelmentioning

confidence: 99%

“…In five of these studies, GFR decline was compared in subgroups with baseline hyperfiltration or normofiltration, with the corresponding number (n) of participants as listed (parentheses). One study (Amin et al [11]) shows GFR decline in combined hyperfiltration and normofiltration subgroups. Black circles, hyperfiltration; white circles, normofiltration; black triangles, hyperfiltration and normofiltration.…”

Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

“…Four [3,11,16,61] of the ten studies [2-4, 9-11, 15, 16, 61, 72] in the meta-analysis used either a more rigorous definition of persistence of increases of AER or a more advanced stage of progression of AER than the standard definition of microalbuminuria ( Table 2). Three of these four studies [3,11,16] reported a significant odds ratio for the association between baseline hyperfiltration and subsequent progression to at least microalbuminuria [7].…”

Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

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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: Prevalence Of Hyperfiltration In Type 1 Diabetesmentioning

confidence: 96%

Section: Measurement Of Gfrmentioning

confidence: 99%

Section: Hyperfiltration At Whole-kidney and Single-nephron Levelmentioning

confidence: 99%

Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

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The clinical significance of hyperfiltration in diabetes

et al. 2010

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Hyperfiltration is associated with the development of microalbuminuria in patients with sickle cell anemia

et al. 2014

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Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

et al. 2019

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Background In patients with diabetes mellitus, hyperfiltration precedes the development of albuminuria. Pediatric sickle cell anemia (SCA) patients have a high prevalence of hyperfiltration and albuminuria during early childhood and adolescence. We tested the hypothesis that hyperfiltration precedes the development of albuminuria in a longitudinal pediatric SCA cohort. Methods We identified 91 participants with HbSS or SB0 thalassemia 5‐21 years of age enrolled in a longitudinal sickle cell nephropathy cohort study who had a cystatin C measured during early childhood (4‐10 years of age). Early hyperfiltration was defined as a mean eGFR >180 mL/min/1.73m2 using cystatin C obtained from 4 to 10 years of age. Persistent albuminuria was defined as an albumin to creatinine ratio > 30 mg/g on two of three untimed urine specimens. Time to event analysis estimated survival curves for participants with and without hyperfiltration using Kaplan‐Meier curves and used logrank test for categorical variables to assess the association with time to development of the first episode persistent albuminuria. Results Persistent albuminuria occurred more often and at an earlier age in participants with early hyperfiltration compared to those without early hyperfiltration (log‐rank, P = .004). Participants who developed albuminuria have a significant increase in their eGFR during childhood (P = .003) as compared to participants who have not yet progressed to albuminuria (P = .26). For every 1 g/dL increase in hemoglobin, the hazard ratio for developing persistent proteinuria decreased by 0.56 (95% CI: 0.3, 1.06, P = .07). Conclusion Hyperfiltration precedes the development of persistent proteinuria in pediatric SCA patients. Intervention strategies should target lowering eGFR during early childhood.

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The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study

Cited by 134 publications

References 48 publications

The clinical significance of hyperfiltration in diabetes

The clinical significance of hyperfiltration in diabetes

Hyperfiltration is associated with the development of microalbuminuria in patients with sickle cell anemia

Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

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