Renal “hyperfiltrators” are at elevated risk of death and chronic diseases

BMC Nephrology

Günay Can³  Tuğba Kemaloğlu-Öz²  Yusuf Karadeniz⁴  Fatma Özpamuk-Karadeniz²  Altan Onat¹  Servet Altay² 

[1] Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey;Cardiology, Siyami Ersek Center for Cardiovascular Surgery, Istanbul, Turkey;Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey;Department of İnternal Medicine, Haseki Training and Research Hospital, Istanbul, Turkey

关键词: Renal hyperfiltration;    Heart failure;    Glomerular filtration rate;    Chronic obstructive pulmonary disease;    Cardiovascular disease;    Autoimmune activation;   

Others  :  1082601
DOI  :  10.1186/1471-2369-15-160

 received in 2014-05-14, accepted in 2014-09-26,  发布年份 2014

【 摘 要 】

Background

The definition of glomerular hyperfiltration has not been agreed upon and the pathophysiological mechanisms have not been well explored. Low serum creatinine concentrations may be associated with increased risk of coronary heart disease (CHD) or cardiopulmonary events the impact of which needs further study.

Methods

Consecutive applicants to a cardiovascular hospital free of moderate/severe chronic kidney disease (age 55.6 ± 8.2 years) were grouped into those without (“healthy”, n = 469) and with CHD (320 stable and acute coronary syndrome cases) at baseline and into sex-specific quartiles of CKD-EPI equation-estimated glomerular filtration rate (eGFR). New or recurrent cardiovascular (myocardial infarction, stroke, heart failure [HF]) events, obstructive pulmonary disease (COPD) and death were determined during 3-years’ follow-up.

Results

Among 25 deaths and 75 cardiopulmonary events, HF was the leading nonfatal event. Age, serum uric acid and left ventricular ejection fraction proved the best independent inverse covariates of eGFR in the “healthy” sample. The highest eGFR quartile (“hyperfiltrators”), exhibiting significantly lower serum LDL-cholesterol levels, significantly predicted the combined outcome (at a RR of 6) in “healthy” subjects, after adjustment for sex, age, body mass index, smoking status and presence of hypertension. This finding was paralleled by the highest eGFR quartile calculated also by the MDRD equation, replicating this also in the CHD group.

Conclusion

Renal “hyperfiltrators” represent individuals with autoimmune activation (involving serum creatinine, partly escaping assay), are misclassified into optimal renal function and actually are at significantly higher risk of death, HF or cardiopulmonary events. Low serum creatinine levels may represent a clue to the existence of autoimmune activation.

【 授权许可】

   
2014 Altay et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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