Renal hyperfiltration and the development of microalbuminuria in type 1 diabetes.
OBJECTIVE
The purpose of this study was to examine prospectively whether renal hyperfiltration is associated with the development of microalbuminuria in patients with type 1 diabetes, after taking into account known risk factors.


METHODS
The study group comprised 426 participants with normoalbuminuria from the First Joslin Kidney Study, followed for 15 years. Glomerular filtration rate was estimated by serum cystatin C, and hyperfiltration was defined as exceeding the 97.5th percentile of the sex-specific distribution of a similarly aged, nondiabetic population (134 and 149 ml/min per 1.73 m(2) for men and women, respectively). The outcome was time to microalbuminuria development (multiple albumin excretion rate >30 microg/min). Hazard ratios (HRs) for microalbuminuria were calculated at 5, 10, and 15 years.


RESULTS
Renal hyperfiltration was present in 24% of the study group and did not increase the risk of developing microalbuminuria. The unadjusted HR for microalbuminuria comparing those with and without hyperfiltration at baseline was 0.8 (95% CI 0.4-1.7) during the first 5 years, 1.0 (0.6-1.7) during the first 10 years, and 0.8 (0.5-1.4) during 15 years of follow-up. The model adjusted for baseline known risk factors including A1C, age at diagnosis of diabetes, diabetes duration, and cigarette smoking resulted in similar HRs. In addition, incorporating changes in hyperfiltration status during follow-up had minimal impact on the HRs for microalbuminuria.


CONCLUSIONS
Renal hyperfiltration does not have an impact on the development of microalbuminuria in type 1 diabetes during 5, 10, or 15 years of follow-up.
Ficociello
Linda H
LH
Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA.
Perkins
Bruce A
BA
Roshan
Bijan
B
Weinberg
Janice M
JM
Aschengrau
Ann
A
Warram
James H
JH
Krolewski
Andrzej S
AS
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology*; D001794:Blood Pressure; D055316:Cystatin C / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012016:Reference Values; D013997:Time Factors; D055815:Young Adult
D055316:Cystatin C