Glomerular hyperfiltration (GHF) in middle-aged healthy adults is independently associated with an increased cardiovascular event risk similar to that of patients with moderate chronic kidney disease (CKD), Canadian investigators reported.
“Glomerular hyperfiltration could be an easily identifiable marker of an unfavorable metabolic milieu and vascular dysfunction,” a team led by Rémi Goupil, MD, MSc, of the Research Centre of the Hôpital du Sacré-Cœur de Montréal, concluded in a paper published in JAMA Network Open. “Therefore, identification of GHF in healthy individuals may provide an opportunity to implement preventive strategies to reduce the global burden of cardiovascular diseases.”
For their study, Dr Goupil and colleagues used longitudinal follow-up data from CARTaGENE population-based cohort, which included 20,004 individuals aged 40 to 69 years selected at random from 4 metropolitan areas in Quebec, Canada. The investigators identified 9515 healthy participants, defined as those without diabetes, hypertension, and cardiovascular disease, did not use statins or aspirin, and who had an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73m2 or higher. From this group, the investigators identified 473 individuals with GHF (median eGFR 112 mL/min/1.73 m2) and 4761 with a normal eGFR (median eGFR 92 mL/min/1.73 m2).
Compared with a normal glomerular filtration rate, GHF was significantly associated with an approximately 1.9-fold increased risk of cardiovascular events after adjusting for age, sex, African-American race, active smoking and numerous other potential confounders. Propensity score matching demonstrated similar findings.
The investigators compared the GHF group with 597 CARTaGENE participants with stage 3a CKD (eGFR 45 to 60 mL/min/1.73 m2) and found no significant difference in cardiovascular event risk between the groups, despite a lesser comorbidity burden and more favorable hemodynamic and metabolic profile in the GHF group.
The researchers defined GHF as an eGFR greater than the 95th percentile and normal eGFR as an eGFR in the 25th to 75th percentiles. They defined cardiovascular events as a composite of cardiovascular mortality, myocardial infarction, unstable angina, heart failure, stroke, and transient ischemic attack.
Dupuis ME, Nadeau-Fredette AC, Madore F, et al. Association of glomerular hyperfiltration and cardiovascular risk in middle-aged healthy individuals. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.2377