Early Glomerular Hyperfiltration and Long-Term Kidney Outcomes in Type 1 Diabetes: The DCCT/EDIC Experience.

Autor:	Molitch ME; Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Gao X; Biostatistics Center, George Washington University, Rockville, Maryland., Bebu I; Biostatistics Center, George Washington University, Rockville, Maryland., de Boer IH; Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington., Lachin J; Biostatistics Center, George Washington University, Rockville, Maryland., Paterson A; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Perkins B; Division of Endocrinology and Metabolism, University of Toronto and University Health Network, Toronto, Ontario, Canada., Saenger AK; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; and., Steffes M; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; and., Zinman B; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2019 Jun 07; Vol. 14 (6), pp. 854-861. Date of Electronic Publication: 2019 May 23.
DOI:	10.2215/CJN.14831218
Abstrakt:	Background and Objectives: Glomerular hyperfiltration has been considered to be a contributing factor to the development of diabetic kidney disease (DKD). To address this issue, we analyzed GFR follow-up data on participants with type 1 diabetes undergoing 125 I-iothalamate clearance on entry into the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications study. Design, Setting, Participants, & Measurements: This was a cohort study of DCCT participants with type 1 diabetes who underwent an 125 I-iothalamate clearance (iGFR) at DCCT baseline. Presence of hyperfiltration was defined as iGFR levels ≥140 ml/min per 1.73 m 2 , with secondary thresholds of 130 or 150 ml/min per 1.73 m 2 . Cox proportional hazards models assessed the association between the baseline hyperfiltration status and the subsequent risk of reaching an eGFR <60 ml/min per 1.73 m 2 . Results: Of the 446 participants, 106 (24%) had hyperfiltration (iGFR levels ≥140 ml/min per 1.73 m 2 ) at baseline. Over a median follow-up of 28 (interquartile range, 23, 33) years, 53 developed an eGFR <60 ml/min per 1.73 m 2 . The cumulative incidence of eGFR <60 ml/min per 1.73 m 2 at 28 years of follow-up was 11.0% among participants with hyperfiltration at baseline, compared with 12.8% among participants with baseline GFR <140 ml/min per 1.73 m 2 . Hyperfiltration was not significantly associated with subsequent risk of developing an eGFR <60 ml/min per 1.73 m 2 in an unadjusted Cox proportional hazards model (hazard ratio, 0.83; 95% confidence interval, 0.43 to 1.62) nor in an adjusted model (hazard ratio, 0.77; 95% confidence interval, 0.38 to 1.54). Application of alternate thresholds to define hyperfiltration (130 or 150 ml/min per 1.73 m 2 ) showed similar findings. Conclusions: Early hyperfiltration in patients with type 1 diabetes was not associated with a higher long-term risk of decreased GFR. Although glomerular hypertension may be a mechanism of kidney injury in DKD, higher total GFR does not appear to be a risk factor for advanced DKD. (Copyright © 2019 by the American Society of Nephrology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu