Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study

Elif Ekinci, Elizabeth Barr, Federica Barzi, Jaqui Hughes, Paul Lawton, Graham R D Jones, Wendy Hoy, Alan Cass, Mark Thomas, Ashim Sinha, George Jerums, Kerin O’Dea, Richard MacIssac, Louise Maple-Brown

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: 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.

    Methods: 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.

    Results: 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.

    Conclusions: 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.
    Original languageEnglish
    Pages (from-to)343-349
    Number of pages7
    JournalJournal of Diabetes and Its Complications
    Volume33
    Issue number5
    Early online date21 Feb 2019
    DOIs
    Publication statusPublished - May 2019

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    Albuminuria
    Albumins
    Creatinine
    Glomerular Filtration Rate
    Urine
    Kidney Diseases
    Iohexol
    Observational Studies
    Longitudinal Studies
    Disease Progression
    Linear Models
    Age Groups
    Kidney

    Cite this

    Ekinci, Elif ; Barr, Elizabeth ; Barzi, Federica ; Hughes, Jaqui ; Lawton, Paul ; Jones, Graham R D ; Hoy, Wendy ; Cass, Alan ; Thomas, Mark ; Sinha, Ashim ; Jerums, George ; O’Dea, Kerin ; MacIssac, Richard ; Maple-Brown, Louise. / Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study. In: Journal of Diabetes and Its Complications. 2019 ; Vol. 33, No. 5. pp. 343-349.
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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",
    abstract = "Background: 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.Methods: 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.Results: 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.Conclusions: 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.",
    keywords = "Albuminuria, Chronic kidney disease, Diabetic kidney disease, Diabetic nephropathy, Hyperfiltration, Indigenous Australians",
    author = "Elif Ekinci and Elizabeth Barr and Federica Barzi and Jaqui Hughes and Paul Lawton and Jones, {Graham R D} and Wendy Hoy and Alan Cass and Mark Thomas and Ashim Sinha and George Jerums and Kerin O’Dea and Richard MacIssac and Louise Maple-Brown",
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    Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study. / Ekinci, Elif; Barr, Elizabeth; Barzi, Federica; Hughes, Jaqui; Lawton, Paul; Jones, Graham R D; Hoy, Wendy; Cass, Alan; Thomas, Mark; Sinha, Ashim; Jerums, George; O’Dea, Kerin; MacIssac, Richard; Maple-Brown, Louise.

    In: Journal of Diabetes and Its Complications, Vol. 33, No. 5, 05.2019, p. 343-349.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Is hyperfiltration associated with higher urine albumin-to-creatinine ratio at follow up among Indigenous Australians? The eGFR follow-up study

    AU - Ekinci, Elif

    AU - Barr, Elizabeth

    AU - Barzi, Federica

    AU - Hughes, Jaqui

    AU - Lawton, Paul

    AU - Jones, Graham R D

    AU - Hoy, Wendy

    AU - Cass, Alan

    AU - Thomas, Mark

    AU - Sinha, Ashim

    AU - Jerums, George

    AU - O’Dea, Kerin

    AU - MacIssac, Richard

    AU - Maple-Brown, Louise

    PY - 2019/5

    Y1 - 2019/5

    N2 - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

    AB - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

    KW - Albuminuria

    KW - Chronic kidney disease

    KW - Diabetic kidney disease

    KW - Diabetic nephropathy

    KW - Hyperfiltration

    KW - Indigenous Australians

    UR - http://www.scopus.com/inward/record.url?scp=85063085469&partnerID=8YFLogxK

    U2 - 10.1016/j.jdiacomp.2019.02.005

    DO - 10.1016/j.jdiacomp.2019.02.005

    M3 - Article

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    SP - 343

    EP - 349

    JO - Journal of Diabetes and Its Complications

    JF - Journal of Diabetes and Its Complications

    SN - 1056-8727

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    ER -