Diabetes Center, Aizawa Hospital, Matsumoto, Japan.
Health Center, Aizawa Hospital, Matsumoto, Japan.
Am J Physiol Renal Physiol. 2020 Dec 1;319(6):F1037-F1041. doi: 10.1152/ajprenal.00305.2020. Epub 2020 Nov 2.
The trajectory of glomerular filtration rate (GFR) in relation to glomerular hyperfiltration (GHF) has been unknown. It was evaluated retrospectively in 23,982 GHF-free health examinees who were followed for 2-10 yr (mean: 5.1 yr). GFR was estimated by the serum creatinine concentration, and GHF was defined as age- and sex-specific estimated GFR (eGFR) ≥ 95% of the Japanese general population. The temporal profile of eGFR was plotted in a GHF-centered way, which was fitted to a random coefficient linear mixed model. Of the 23,982 subjects, 797 and 23,185 subjects developed or did not develop GHF, respectively, so that they were termed as the GHF and GHF groups. At baseline, median eGFR was significantly elevated in the GHF group compared with in the GHF group: 94.1 versus 77.3 mL/min/1.73 m ( < 0.001). Elevation of basal eGFR lasted for a mean (SD) of 3.3 (1.9) yr in the GHF group; mean eGFR then rose to the GHF range, which was 108.5 mL/min/1.73 m. The eGFR decline after the peak was steeper in the GHF group than in the GHF group: -0.984 versus -0.497 mL/min/1.73 m/yr ( < 0.001). Baseline eGFR, but no other variable, well predicted incident GHF, with an area under the receiver operating characteristic curve of 0.87 (95% confidence interval: 0.86-0.88). In conclusion, GHF occurs as a chronic, multiphasic phenomenon: initially with a sustained GFR elevation for years, followed by a GFR surge to the GHF range, which was accompanied by accelerated GFR declining.
肾小球滤过率（GFR）与肾小球高滤过（GHF）的关系轨迹尚不清楚。我们对 23982 例无 GHF 的健康体检者进行了回顾性评估，这些人随访了 2-10 年（平均：5.1 年）。GFR 通过血清肌酐浓度估算，GHF 定义为年龄和性别特异性估算 GFR（eGFR）≥日本普通人群的 95%。eGFR 的时间分布以 GHF 为中心绘制，并拟合随机系数线性混合模型。在 23982 例受试者中，797 例和 23185 例分别发展为或未发展为 GHF，因此将其分为 GHF 组和 GHF 组。在基线时，GHF 组的中位 eGFR 显著高于 GHF 组：94.1 比 77.3 mL/min/1.73 m（<0.001）。GHF 组基础 eGFR 升高持续平均（SD）3.3（1.9）年；平均 eGFR 随后上升到 GHF 范围，为 108.5 mL/min/1.73 m。GHF 组的 eGFR 峰值后下降速度快于 GHF 组：-0.984 比-0.497 mL/min/1.73 m/yr（<0.001）。基线 eGFR 而非其他变量能很好地预测 GHF 的发生，其受试者工作特征曲线下面积为 0.87（95%置信区间：0.86-0.88）。总之，GHF 是一种慢性、多相现象：最初是多年持续的 GFR 升高，随后是 GFR 飙升至 GHF 范围，同时伴有 GFR 加速下降。
