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

doi:10.2337/dc11-2189

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

Istituto di Ricerche Farmacologiche "Mario Negri"

Research output: Contribution to journal › Article

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 language	English
Pages (from-to)	2061-2068
Number of pages	8
Journal	Diabetes Care
Volume	35
Issue number	10
DOIs	https://doi.org/10.2337/dc11-2189
Publication status	Published - 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

Glomerular hyperfiltration and renal disease progression in type 2 diabetes. / Ruggenenti, Piero; Porrini, Esteban L.; Gaspari, Flavio; Motterlini, Nicola; Cannata, Antonio; Carrara, Fabiola; Cella, Claudia; Ferrari, Silvia; Stucchi, Nadia; Parvanova, Aneliya; Iliev, Ilian; Dodesini, Alessandro Roberto; Trevisan, Roberto; Bossi, Antonio; Zaletel, Jelka; Remuzzi, Giuseppe.

In: Diabetes Care, Vol. 35, No. 10, 10.2012, p. 2061-2068.

Research output: Contribution to journal › Article

Ruggenenti, Piero ; Porrini, Esteban L. ; Gaspari, Flavio ; Motterlini, Nicola ; Cannata, Antonio ; Carrara, Fabiola ; Cella, Claudia ; Ferrari, Silvia ; Stucchi, Nadia ; Parvanova, Aneliya ; Iliev, Ilian ; Dodesini, Alessandro Roberto ; Trevisan, Roberto ; Bossi, Antonio ; Zaletel, Jelka ; Remuzzi, Giuseppe. / Glomerular hyperfiltration and renal disease progression in type 2 diabetes. In: Diabetes Care. 2012 ; Vol. 35, No. 10. pp. 2061-2068.

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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.",

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

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T1 - Glomerular hyperfiltration and renal disease progression in type 2 diabetes

AU - Ruggenenti, Piero

AU - Porrini, Esteban L.

AU - Gaspari, Flavio

AU - Motterlini, Nicola

AU - Cannata, Antonio

AU - Carrara, Fabiola

AU - Cella, Claudia

AU - Ferrari, Silvia

AU - Stucchi, Nadia

AU - Parvanova, Aneliya

AU - Iliev, Ilian

AU - Dodesini, Alessandro Roberto

AU - Trevisan, Roberto

AU - Bossi, Antonio

AU - Zaletel, Jelka

AU - Remuzzi, Giuseppe

PY - 2012/10

Y1 - 2012/10

N2 - 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.

AB - 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.

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