Renal hyperfiltration defined by high estimated glomerular filtration rate: A risk factor for cardiovascular disease and mortality

Abstract

Renal hyperfiltration, defined as an increased glomerular filtration rate above normal values, is associated with early phases of kidney disease in the setting of various conditions such as obesity and diabetes. Although it is recognized that glomerular hyperfiltration, that is, increased filtration per nephron unit (usually studied at low glomerular filtration levels and often referred to as single nephron hyperfiltration), is a risk factor for the progression of chronic kidney disease, the implications of having renal hyperfiltration for cardiovascular disease and mortality risk are incompletely understood. Recent evidence from diverse populations, including healthy individuals and patients with diabetes or established cardiovascular disease, suggests that renal hyperfiltration is associated with a higher risk of cardiovascular disease and all‐cause mortality. In this review, we critically summarize the existing studies, discuss possible mechanisms, and describe the remaining gaps in our knowledge regarding the association of renal hyperfiltration with cardiovascular disease and mortality risk.

A Clinical Association between an Increasing Renal Resistive Index and the Atherosclerotic Burden in Patients with a Preserved Renal Function

“…Interestingly, renal hyperfiltration -defined as an eGFR>90 mL/min/1.73 m 2 -was associated with multi-site atherosclerosis in our study. Hyperfiltration caused by diabetic nephropathy is already known to be associated with endothelial dysfunction with a subsequent risk of cardiovascular events (32). In the present study, diabetic patients showed hyperfiltration more frequently than those without diabetes (50.0% vs. 23.3%, p= 0.03).…”

Renal hyperfiltration is independently associated with increased all-cause mortality in individuals with type 2 diabetes: a prospective cohort study

“…Second, the association between high eGFR/hyperfiltration and mortality may reflect early pathological changes occurring both in the kidney and in other vascular beds, possibly mediated by common mechanisms including RAS and sympathetic nervous system activation, which may be responsible for both hyperfiltration and premature death, with the former that may act either as a marker or a mediator of the increased mortality risk. 13 This concept is supported by the association of high eGFR/hyperfiltration with CVD risk factors, 38 40 subclinical CVD, 22 38 41 and CVD events. 22 27 42 43 However, high eGFR/hyperfiltration was not found to be associated with CVD mortality in most studies 10-12 33 44 and also the association with CVD events was not always observed.…”

“… 10 12 A recent systematic review has suggested that renal hyperfiltration is indeed associated with a higher risk of death and CVD. 13 Unfortunately, the studies considered in this review were mostly retrospective and included individuals from either the general population or selected disease groups of various size and different risk, and only some of them reported measurements of albuminuria/proteinuria or were specifically focused on hyperfiltration. More importantly, most of these studies did not evaluate ‘hyperfiltering’ individuals, but only those falling in the highest eGFR category, which included people with high-normal eGFR values below the hyperfiltration threshold, at variance with older patients falling in other categories, who may have exceeded the age-corrected threshold.…”

New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction

“…Необходимо отметить, что несмотря на соответствие значений КлКр >95/мин норме, у части пациентов высокие цифры данного показателя могут являться признаком гиперфильтрации -патологического компенсаторного состояния, развивающегося при гибели части клубочков на начальных стадиях ХБП и сигнализирующего о высоком риске ее прогрессирования и неблагоприятном прогнозе [58]. Данное состояние наиболее изучено у пациентов с сахарным диабетом и метаболическими нарушениями; поэтому в пользу наличия гиперфильтрации у части пациентов с супранормальной функцией почек в исследовании RE-LY свидетельствует то, что они характеризовались более молодым возрастом и наличием избыточного веса, чем больные с более низкими значениями КлКр [55].…”