Glomerular hyperfiltration and renal disease progression in type 2 diabetes

Piero Ruggenenti, Esteban L. Porrini, Flavio Gaspari, Nicola Motterlini, Antonio Cannata, Fabiola Carrara, Claudia Cella, Silvia Ferrari, Nadia Stucchi, Aneliya Parvanova, Ilian Iliev, Alessandro Roberto Dodesini, Roberto Trevisan, Antonio Bossi, Jelka Zaletel, Giuseppe Remuzzi

Research output: Contribution to journalArticle

Abstract

OBJECTIVE - To describe the prevalence and determinants of hyperfiltration (glomerular filtration rate [GFR] ≥120 mL/min/1.73 m2), GFR decline, and nephropathy onset or progression in type 2 diabetic patients with normo- or microalbuminuria. RESEARCH DESIGN AND METHODS - We longitudinally studied 600 hypertensive type 2 diabetic patients with albuminuria 1c was 2 per year. GFR change was bimodal over time: a larger reduction at 6 months significantly predicted slower subsequent decline (coefficient: -0.0054; SE: 0.0009), particularly among hyperfiltering patients. A total of 90 subjects (15%) were hyperfiltering at inclusion, and 11 of 47 (23.4%) patients with persistent hyperfiltration progressed to micro- or macroalbuminuria versus 53 (10.6%) of the 502 who had their hyperfiltration ameliorated at 6 months or were nonhyperfiltering since inclusion (hazard ratio 2.16 [95% CI 1.13-4.14]). Amelioration of hyperfiltration was independent of baseline characteristics or ACE inhibition. It was significantly associated with improved BP and metabolic control, amelioration of GDR, and slower long-term GFR decline on follow-up. CONCLUSIONS - Despite intensified treatment, patients with type 2 diabetes have a fast GFR decline. Hyperfiltration affects a subgroup of patients and may contribute to renal function loss and nephropathy onset or progression. Whether amelioration of hyperfiltration is renoprotective is worth investigating.

Original languageEnglish
Pages (from-to)2061-2068
Number of pages8
JournalDiabetes Care
Volume35
Issue number10
DOIs
Publication statusPublished - Oct 2012

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Ruggenenti, P., Porrini, E. L., Gaspari, F., Motterlini, N., Cannata, A., Carrara, F., Cella, C., Ferrari, S., Stucchi, N., Parvanova, A., Iliev, I., Dodesini, A. R., Trevisan, R., Bossi, A., Zaletel, J., & Remuzzi, G. (2012). Glomerular hyperfiltration and renal disease progression in type 2 diabetes. Diabetes Care, 35(10), 2061-2068. https://doi.org/10.2337/dc11-2189