Glomerular hyperfiltration: A new marker of metabolic risk

Abstract

Chronic kidney disease coexists with metabolic syndrome and this relationship may be apparent before overt manifestations of cardiovascular disease. To investigate early stages of the natural history of associations between renal function and metabolic syndrome, we phenotyped 1572 young (mean age=18.4 years), apparently healthy men for metabolic risk factors and estimated their creatinine clearance based on the Cockcroft-Gault equation. High metabolic risk (clustering of at least three metabolic risk factors) was revealed in 8.7% (137) of the subjects and was associated with a 6.9-fold increase in the odds of glomerular hyperfiltration (95% confidence interval (CI): 3.9-11.5) when compared to reference (from none to two metabolic risk factors). Overweight, elevated blood pressure, and low high-density lipoprotein (HDL) cholesterol increased the multivariate-adjusted odds ratio of glomerular hyperfiltration to 6.6 (95% CI: 3.8-11.6), 1.8 (95% CI: 1.0-3.0), and 2.5 (95% CI: 1.5-4.3), respectively. Systolic and diastolic blood pressures clustered together with leptin in the factor analysis and this blood pressure-adiposity component correlated with estimated creatinine clearance (r=0.329, P<0.0001) and explained on its own 10.2% of the variance in the estimated renal function. Our data reveal the silent epidemics of metabolic risk among young, apparently healthy men. Furthermore, the results indicate that high metabolic risk is associated with glomerular hyperfiltration before overt manifestations of cardiovascular disease.

Pathological influence of obesity on renal structural changes in chronic kidney disease

“…Many studies investigated that BMI and blood pressure was associated with glomerular lesions in ORG patients [5,6,17,18]. In hypertensive patients, increasing renal tubular sodium reabsouption and glomerular hyperfiltration may cause glomerulomegaly [1].…”

The clinical significance of hyperfiltration in diabetes

“…It has also been claimed that the metabolic syndrome is associated with hyperfiltration, as estimated by the Cockcroft-Gault formula [33]. However, GFR estimates by the Cockcroft-Gault formula may be spuriously elevated in obese participants.…”

Association between management of metabolic syndrome and progression of early-stage chronic kidney disease: an observational cohort study

“…18 The proposed mechanisms to explain renal damage induced by MetS are hyperfiltration, proinflammatory and prothrombotic state, endothelial dysfunction, and oxidative stress. 12,13,19,20 To circumvent these issues, MetS had been identified as initiating factor of CKD and had the impact on renal function progression in diabetic or nondiabetic early-stage CKD. 6,8,16 A sizeable study utilizing data from the Atherosclerosis Risk in Communities cohort confirmed a step-wise increase with the risk of developing CKD, each MetS criterion met by non-diabetic adults, even after putting in place prophylactic measures for the possible development of diabetes mellitus and hypertension.…”