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Title: Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study.
Austin Authors: Ekinci, Elif I ;Barr, Elizabeth L M;Barzi, Federica;Hughes, Jaquelyne T;Lawton, Paul D;Jones, Graham R D;Hoy, Wendy;Cass, Alan;Thomas, Mark;Sinha, Ashim;Jerums, George ;O'Dea, Kerin;MacIsaac, Richard J;Maple-Brown, Louise J
Affiliation: University of New South Wales Sydney, Sydney, Australia
School of Population Health, University of South Australia, Australia
Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne and the University of Melbourne, Melbourne, Australia
Diabetes and Endocrinology, Cairns Base Hospital, Cairns, Australia
Royal Perth Hospital, Perth, Australia
Menzies School of Health Research, Charles Darwin University, Australia
The University of Queensland Centre for Chronic Disease, Queensland, Australia
Medicine (University of Melbourne)
Baker Heart and Diabetes Institute, Melbourne, Australia
Division of Medicine, Royal Darwin Hospital, Darwin, Australia
SydPath, St Vincent's Hospital, Sydney, Australia
Issue Date: May-2019
Date: 2019-02-21
Publication information: Journal of Diabetes and Its Complications 2019; 33(5): 343-349
Abstract: Glomerular hyperfiltration is not able to be detected in clinical practice. We assessed whether hyperfiltration is associated with albuminuria progression among Indigenous Australians at high risk of diabetes and kidney disease to determine its role in kidney disease progression. Longitudinal observational study of Indigenous Australians aged ≥18 years recruited from >20 sites, across diabetes and/or kidney function strata. At baseline, iohexol clearance was used to measure glomerular filtration rate (mGFR) and hyperfiltration was defined as (i) a mGFR of ≥125 mL/min/1.73 m2, and (ii) an age-adjusted definition, with the top 10% of the mGFR for each 10 year age group at baseline. Baseline and follow-up urine albumin-to-creatinine ratio (uACR) was collected, and linear regression was used to assess the associations of hyperfiltration and uACR at follow up. 407 individuals (33% men, mean age 47 years) were followed-up for a median of 3 years. At baseline, 234 had normoalbuminuria and 173 had albuminuria. Among participants with normoalbuminuria, those with mGFR ≥125 mL/min/1.73 m2 had 32% higher uACR at follow-up (p = 0.08), and those with age-adjusted hyperfiltration had 60% higher uACR (p = 0.037) compared to those who had normofiltration. These associations were independent of uACR at baseline, but attenuated by HbA1c. Associations were stronger among those without than those with albuminuria at baseline. Although not available for assessment in current clinical practice, hyperfiltration may represent a marker of subsequent albuminuria progression among individuals who have not yet developed albuminuria.
DOI: 10.1016/j.jdiacomp.2019.02.005
ORCID: 0000-0003-2372-395X
Journal: Journal of Diabetes and Its Complications
PubMed URL: 30904420
Type: Journal Article
Subjects: Albuminuria
Chronic kidney disease
Diabetic kidney disease
Diabetic nephropathy
Indigenous Australians
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