Glomerular hyperfiltration may increase CVD risk for patients with type 2 diabetes
Key takeaways:
- Results showed highest risks for CVD for low eGFR and high GFR.
- Overall, 214,111 patients developed CVD during the study.
Glomerular hyperfiltration may increase CVD risks, including myocardial infarction and heart failure, for patients with type 2 diabetes, study data show.
It is known “that diabetic kidney disease is an independent risk factor of cardiovascular [CVD] and its associated mortality, strengthening evidence for annual checkups for albuminuria and eGFR with optimal glycemic and [blood pressure] BP control,” Seung Min Chung, MD, PhD, of the division of endocrinology and metabolism and department of internal medicine at Yeungnam University College of Medicine in the Republic of Korea, wrote with colleagues. “However, the effect of glomerular hyperfiltration (GHF), which is an abnormally elevated GFR, on the risk of CVD in patients with diabetes is not well understood.”
Researchers conducted a retrospective cohort analysis of data from 1,952,053 patients from the Korean National Health Insurance Service database from 2015 and 2016. The cohort, all diagnosed with type 2 diabetes, was categorized into five groups: low filtration with eGFR levels below 5 mL/min per 1.72 m2; eGFRs between 5 mL/min per 1.72 m2 and 40 mL/min per 1.72 m2; eGFRs between 40 mL/min per 1.72 m2 and 60 mL/min per 1.72 m2; eGFRs between 60 mL/min per 1.72 m2 and 95 mL/min per 1.72 m2; and glomerular hyperfiltration with eGFR levels above 95 mL/min per 1.72 m2.
Patients with myocardial infarction, stroke and heart failure were followed until 2022.
Results showed an inverted “J-shaped” relationship between eGFR and CVD, with the highest risk in patients with low filtration, followed by glomerular hyperfiltration. Overall, 214,111 patients developed CVD, with incidence rates of 36.1, 20.8, 18.3, 18.7 and 19.3 per 1,000 person-years across the eGFR groups, respectively.
Hazard ratios for CVD showed low filtration (HR = 1.56; 95% CI, 1.53-1.59) and glomerular hyperfiltration (HR = 1.13; 95% CI, 1.10-1.15) presented higher risks compared with eGFR levels within the 40th and 60th percentile range.
Chung and colleagues found glomerular hyperfiltration was linked to a higher likelihood of myocardial infarction (HR = 1.06; 95% CI, 1.01-1.11) and heart failure (HR = 1.17; 95% CI, 1.14-1.20). In addition, eGFR was linked to CVD risk across varying age, sex, obesity, hypertension and dyslipidemia subgroups within the cohort.
Further, researchers found the impact of glomerular hyperfiltration on cardiovascular disease risk was higher for younger patients. (HRs = 1.30, 1.17 and 1.05 for patients younger than 40 years, patients aged between 40 and 60 years and patients aged 65 years or older, respectively).
Patients with glomerular hyperfiltration were generally younger with fewer comorbid metabolic disorders, according to the researchers, despite poor glycemic control.
“Early identification of GHF in patients with type 2 diabetes mellitus may offer an opportunity for preventive strategies to lower the risk of CVD,” they wrote.
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