Hyperfiltration in normoalbuminuric type 1 diabetic patients: relationship with urinary albumin excretion rate [Utjecaj hiperfiltracije na razinu albumina u urinu u normoalbuminuričnih bolesnika s tipom 1 šećerne bolesti]

Bulum, Tomislav and Kolarić, Branko and Prkačin, Ingrid and Duvnjak, Lea (2013) Hyperfiltration in normoalbuminuric type 1 diabetic patients: relationship with urinary albumin excretion rate [Utjecaj hiperfiltracije na razinu albumina u urinu u normoalbuminuričnih bolesnika s tipom 1 šećerne bolesti]. Collegium Antropologicum, 37 (2). pp. 471-476. ISSN 0350-6134

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Abstract

Hyperfiltration has been documented in type 1 diabetes and may contribute to the high risk for development of albuminuria and progression of nephropathy. However, recent studies suggest that the risk of progression to albuminuria in type 1 diabetes was not increased by hyperfiltration. We investigated associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (UAE) in normoalbuminuric type 1 diabetic patients. Study included 313 normoalbuminuric patients with type 1 diabetes, none showed signs of adrenal, renal, or cardiovascular diseases. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Glomerular hyperfiltration was defined as eGFR > or = 125 mL min(-1) 1.73 m(-2). Renal hyperfiltration was present in 12% of the study group. Subjects with eGFR > or = 125 mL min(-1) 1.73 m(-2) were younger, had shorter duration of diabetes, lower levels of total and LDL cholesterol, and higher HbA1c than subjects with an eGFR below 125 mL min(-1) 1.73 m(-2). Type 1 diabetic patients with hyperfiltration also had significantly lower UAE. In a multiple logistic regression analysis, higher eGFR was associated with lower UAE. Our results indicate that normoalbuminuric type 1 diabetic patients with hyperfiltration have lower UAE than those with renal function in the normal range. Together with other recent studies this may suggest that creatinine-based estimates of GFR indicating hyperfiltration is not associated with higher UAE and subsequent development of microalbuminuria.

Abstract in Croatian

Glomerularna hiperfiltracija je česta kod bolesnika s tipom 1 šećerne bolesti i dugi niz godina je prepoznata kao rizični čimbenik razvoja mikro- i makroalbuminurije te nefropatije. Međutim, novije prospektivne studije na velikom broju ispitanika s tipom 1 šećerne bolesti nisu potvrdile da hiperfiltracija doprinosi razvoju mikroalbuminurije. Istraživali smo povezanost glomerularne filtracije (GF) i razine albumina u urinu u normoalbuminuričnih bolesnika s tipom 1 šećerne bolesti. U istraživanje je uključeno 313 bolesnika s tipom 1 šećerne bolesti koji nisu imali poremećaj funkcije nadbubrežne žlijezde, bubrežnu insuficijenciju ili kardiovaskularnu bolest. GF je izračunata prema Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formuli. Glomerularna hiperfiltracija je definirana kao vrijednost GF > ili = 125 mL min–1 1,73 m–2. Glomerularna hiperfiltracija je bila prisutna u 12% ispitanika. Ispitanici s GF > ili = 125 mL min–1 1,73 m–2 bili su mlađi, imali su kraće trajanje šećerne bolesti, nižu razinu ukupnog i LDL kolesterola te višu razinu HbA1c u odnosu na ispitanike s GF <125 mL min–1 1,73 m–2. Bolesnici s glomerularnom hiperfiltracijom su imali statistički značano nižu razinu albumina u urinu. Multiplom logističkom regresijom viša vrijednost GF bila je povezana s nižom razinom albumina u urinu. Rezultati našeg istraživanja ukazuju da je serumskim kreatininom izračunata glomerularna hiperfiltracija povezana s nižom razinom albumina u urinu u normoalbuminuričnih bolesnika s tipom 1 šećerne bolesti. Rezultati našeg istraživanja su u skladu s rezultatima novijih istraživanja koji ukazuju da glomerularna hiperfiltracija nije rizični čimbenik kasnijeg razvoja mikroalbuminurije u bolesnika s tipom 1 šećerne bolesti.

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