Prediabetes linked to increased risk of hyperfiltration and albuminuria

Middle-aged adults with prediabetes are at increased risk of developing glomerular hyperfiltration and albuminuria, reports a study in The American Journal of Kidney Diseases.

The researchers analyzed prospective data on a general population sample of 1261 Norwegian adults drawn from the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6) Study and the RENIS Follow-Up Study. At baseline, subjects were 50 to 62 years old and free of diabetes. On the basis of fasting glucose and hemoglobin A1c levels, 595 participants had prediabetes according to American Diabetes Association criteria, and 169 participants had prediabetes according to International Expert Committee of 2009 (IEC) criteria.

At a median follow-up of 5.6 years, change in measured GFR (mGFR) was compared between groups; hyperfiltration was defined as mGFR above the 90th percentile adjusted for age, sex, height, and weight. Rates of high-normal urinary albumin-to-creatinine ratio (ACR; greater than 10 mg/g) were assessed as well.

On multivariable analysis, both sets of prediabetes criteria predicted an increased mGFR at follow-up and a lower annual rate of decline in mGFR. Baseline fasting glucose and HbA1c were also significant predictors. In the smaller group of patients meeting IEC criteria, odds ratios were 1.92 for hyperfiltration and 1.83 for high-normal ACR. The associations remained significant after adjustment for baseline BP, use of antihypertensive medications, and other cardiovascular risk factors [Melsom T, et al. Prediabetes and risk of glomerular hyperfiltration and albuminuria in the general nondiabetic population: A prospective cohort study. Am J Kidney Dis 2016; 67:841–850].″