Rapid GFR decline is associated with renal hyperfiltration and impaired GFR in adults with Type 1 diabetes

Nephrol Dial Transplant. 2015 Oct;30(10):1706-11. doi: 10.1093/ndt/gfv121. Epub 2015 Jun 6.

Abstract

Background: Rapid glomerular filtration rate (GFR) decline (>3 mL/min/1.73 m(2)) is an increasingly recognized high-risk diabetic nephropathy (DN) phenotype in Type 1 diabetes. Rapid GFR decline is a recognized predictor of impaired GFR (<60 mL/min/1.73 m(2)). However, the association between rapid GFR decline and renal hyperfiltration is not well described in Type 1 diabetes. We hypothesized that renal hyperfiltration (estimated glomerular filtration rate, eGFR ≥ 120 mL/min/1.73 m(2)) would predict rapid GFR decline over 6 years and that rapid GFR decline would predict impaired GFR at 6 years in adults with Type 1 diabetes.

Methods: GFR was calculated by chronic kidney disease epidemiology (CKD-EPI) creatinine in 646 adults with Type 1 diabetes in the coronary artery calcification in Type 1 diabetes study. Logistic multivariable models were employed to investigate the relationships between renal hyperfiltration and rapid GFR decline, and rapid GFR decline and incident impaired GFR over 6 years.

Results: Renal hyperfiltration predicted greater odds of rapid GFR decline over 6 years [odds ratio (OR): 5.00, 95% confidence interval (CI): 3.03-8.25, P < 0.0001] adjusting for hemoglobin A1c (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), sex, duration, log of albumin/creatinine ratio and estimated insulin sensitivity. Furthermore, rapid GFR decline predicted greater odds of incident impaired eGFR (OR: 15.99, 95% CI 2.34-114.37, P = 0.006) in a similarly adjusted model. Sensitivity analyses with GFR calculated by CKD-EPI combined creatinine and cystatin C, and renal hyperfiltration defined as ≥135 mL/min/1.73 m(2) yielded similar results.

Conclusions: In adults with Type 1 diabetes, rapid GFR decline over 6 years was associated with baseline renal hyperfiltration and incident GFR impairment. These observations may suggest an intermediate and predictive role of rapid GFR decline in the progression of DN.

Keywords: CKD-EPI creatinine and cystatin C; diabetic nephropathy; glomerular filtration rate (GFR); rapid GFR decline; renal hyperfiltration.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Pressure Determination
  • Calcinosis / complications*
  • Coronary Artery Disease / complications*
  • Creatinine / blood
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / etiology
  • Disease Progression
  • Female
  • Glomerular Filtration Rate*
  • Glycated Hemoglobin / analysis
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / etiology
  • Risk Factors
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • Creatinine