TY - JOUR
T1 - Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study
AU - Ekinci, Elif I.
AU - Barr, Elizabeth L.M.
AU - Barzi, Federica
AU - Hughes, Jaquelyne T.
AU - Lawton, Paul D.
AU - Jones, Graham R.D.
AU - Hoy, Wendy
AU - Cass, Alan
AU - Thomas, Mark
AU - Sinha, Ashim
AU - Jerums, George
AU - O'Dea, Kerin
AU - MacIsaac, Richard J.
AU - Maple-Brown, Louise J.
PY - 2019/5
Y1 - 2019/5
N2 - Background: Glomerular hyperfiltration is not able to be detected in clinical practice. We assessed whether hyperfiltration is associated with albuminuria progression among Indigenous Australians at high risk of diabetes and kidney disease to determine its role in kidney disease progression. Methods: Longitudinal observational study of Indigenous Australians aged ≥18 years recruited from >20 sites, across diabetes and/or kidney function strata. At baseline, iohexol clearance was used to measure glomerular filtration rate (mGFR) and hyperfiltration was defined as (i) a mGFR of ≥125 mL/min/1.73 m 2 , and (ii) an age-adjusted definition, with the top 10% of the mGFR for each 10 year age group at baseline. Baseline and follow-up urine albumin-to-creatinine ratio (uACR) was collected, and linear regression was used to assess the associations of hyperfiltration and uACR at follow up. Results: 407 individuals (33% men, mean age 47 years) were followed-up for a median of 3 years. At baseline, 234 had normoalbuminuria and 173 had albuminuria. Among participants with normoalbuminuria, those with mGFR ≥125 mL/min/1.73 m 2 had 32% higher uACR at follow-up (p = 0.08), and those with age-adjusted hyperfiltration had 60% higher uACR (p = 0.037) compared to those who had normofiltration. These associations were independent of uACR at baseline, but attenuated by HbA 1c . Associations were stronger among those without than those with albuminuria at baseline. Conclusions: Although not available for assessment in current clinical practice, hyperfiltration may represent a marker of subsequent albuminuria progression among individuals who have not yet developed albuminuria.
AB - Background: Glomerular hyperfiltration is not able to be detected in clinical practice. We assessed whether hyperfiltration is associated with albuminuria progression among Indigenous Australians at high risk of diabetes and kidney disease to determine its role in kidney disease progression. Methods: Longitudinal observational study of Indigenous Australians aged ≥18 years recruited from >20 sites, across diabetes and/or kidney function strata. At baseline, iohexol clearance was used to measure glomerular filtration rate (mGFR) and hyperfiltration was defined as (i) a mGFR of ≥125 mL/min/1.73 m 2 , and (ii) an age-adjusted definition, with the top 10% of the mGFR for each 10 year age group at baseline. Baseline and follow-up urine albumin-to-creatinine ratio (uACR) was collected, and linear regression was used to assess the associations of hyperfiltration and uACR at follow up. Results: 407 individuals (33% men, mean age 47 years) were followed-up for a median of 3 years. At baseline, 234 had normoalbuminuria and 173 had albuminuria. Among participants with normoalbuminuria, those with mGFR ≥125 mL/min/1.73 m 2 had 32% higher uACR at follow-up (p = 0.08), and those with age-adjusted hyperfiltration had 60% higher uACR (p = 0.037) compared to those who had normofiltration. These associations were independent of uACR at baseline, but attenuated by HbA 1c . Associations were stronger among those without than those with albuminuria at baseline. Conclusions: Although not available for assessment in current clinical practice, hyperfiltration may represent a marker of subsequent albuminuria progression among individuals who have not yet developed albuminuria.
KW - Albuminuria
KW - Chronic kidney disease
KW - Diabetic kidney disease
KW - Diabetic nephropathy
KW - Hyperfiltration
KW - Indigenous Australians
UR - http://www.scopus.com/inward/record.url?scp=85063085469&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/545202
UR - http://purl.org/au-research/grants/NHMRC/1021460
UR - http://purl.org/au-research/grants/NHMRC/631947
UR - http://purl.org/au-research/grants/NHMRC/1054312
UR - http://purl.org/au-research/grants/NHMRC/605837
UR - http://purl.org/au-research/grants/NHMRC/1078477
UR - http://purl.org/au-research/grants/NHMRC/490348
UR - http://purl.org/au-research/grants/NHMRC/1092576
U2 - 10.1016/j.jdiacomp.2019.02.005
DO - 10.1016/j.jdiacomp.2019.02.005
M3 - Article
C2 - 30904420
AN - SCOPUS:85063085469
SN - 1056-8727
VL - 33
SP - 343
EP - 349
JO - Journal of Diabetes and Its Complications
JF - Journal of Diabetes and Its Complications
IS - 5
ER -