Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Global Database Studies, IQVIA, Espoo, Finland.
Int Urol Nephrol. 2022 Jul;54(7):1673-1680. doi: 10.1007/s11255-021-03048-6. Epub 2021 Nov 3.
While the impact of low glomerular filtration rate (eGFR) on various outcomes has been extensively studied, the other adverse occurrence, renal hyperfiltration (RHF), remains understudied, poorly defined, and, therefore, its impact on mortality unestablished.
Using a population-based subcohort from the Kuopio Ischaemic Disease Risk Factor Study restricted to non-diabetic Finnish men aged 54 or 55 years, we followed up n = 1179 study participants for up to 35 years. We evaluated the hazard of all-cause mortality associated to RHF at different cutoff points defining eGFR. Based on models' accuracy we suggested an optimal eGFR cutoff point for the definition of RHF. We divided the RHF category to three subgroups and evaluated them in terms of baseline characteristics and mortality hazard.
The eGFR value of 97 mL/min/1.73 m corresponded to the models with the highest accuracy. Overall RHF associated with an increased risk of mortality (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.21 to 1.67). Moderate RHF associated with a decreased HR of mortality when compared to mild (0.64; 95% CI 0.46 to 0.9) or to extreme RHF (0.61; 95% CI 0.43 to 0.85), suggesting a rather U-shaped relationship between RHF's eGFR values and mortality hazard.
The burden of increased eGFR within what is still considered normal eGFR category was highly underestimated. RHF's eGFR values had a U-shaped association with the risk of overall mortality. A more uniform consensual definition of RHF is needed, as higher to normal eGFR values that are not without consequences.
虽然肾小球滤过率（eGFR）降低对各种结局的影响已得到广泛研究，但另一种不良事件——肾高滤过（RHF）仍研究不足，定义不明确，因此其对死亡率的影响尚未确定。
我们使用来自库奥皮奥缺血性疾病风险因素研究的一个基于人群的亚队列，该亚队列仅限于年龄为 54 或 55 岁的非糖尿病芬兰男性，对 1179 名研究参与者进行了长达 35 年的随访。我们评估了不同 eGFR 截断值定义的 RHF 与全因死亡率的危险比。根据模型的准确性，我们建议了一个最佳的 eGFR 截断值来定义 RHF。我们将 RHF 类别分为三个亚组，并根据基线特征和死亡率危险来评估它们。
eGFR 值为 97 mL/min/1.73 m 对应于具有最高准确性的模型。总体 RHF 与死亡率增加的风险相关（危险比 [HR] 1.42；95%置信区间 [CI] 1.21 至 1.67）。与轻度 RHF（0.64；95% CI 0.46 至 0.9）或与重度 RHF（0.61；95% CI 0.43 至 0.85）相比，中度 RHF 与死亡率降低的 HR 相关，表明 RHF 的 eGFR 值与死亡率危险之间存在相当 U 形关系。
在仍被认为是正常 eGFR 范围内的 eGFR 升高的负担被严重低估。RHF 的 eGFR 值与全因死亡率的风险呈 U 形相关。需要更统一的 RHF 共识定义，因为较高的正常 eGFR 值并非没有后果。
