Kwon Seong Soon, Lee Haekyung, Park Byoung-Won, Kwon Soon Hyo, Bang Duk Won, Jeon Jin Seok, Noh Hyunjin, Kim Hyoungnae
Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Republic of Korea.
Atherosclerosis. 2023 Mar;369:30-36. doi: 10.1016/j.atherosclerosis.2023.01.016. Epub 2023 Jan 24.
Glomerular hyperfiltration (GHF) is a hemodynamic change of the kidney as an adaptive response to nephron loss. Although GHF is associated with metabolic risk factors and cardiovascular disease (CVD), the mechanisms that explain these relationships remain largely unknown. This is partially caused by a non-unified definition of GHF based on pathophysiologic vascular changes. Thus, the objective of this study was to evaluate the association between various definitions of GHF and carotid plaque in a health checkup cohort.
A total of 4493 individuals without history of CVD who had carotid ultrasonography (USG) results available between January 2016 and June 2018 were enrolled. GHF was defined as >90th percentile of eGFR residuals after adjusting for confounding factors. Carotid plaque score was calculated based on carotid USG results.
Of 4493 individuals (mean age, 52.3 ± 10.1 years; 3224 [71.8%] males), 449 subjects were included in the GHF group (mean eGFR, 107.0 ± 7.1 ml/min/1.73 m) and 4044 subjects were included in the non-GHF group (mean eGFR, 92.5 ± 12.3 ml/min/1.73 m). When the GHF group was compared to the non-GHF group, GHF was associated with the presence of significant carotid plaque (carotid plaque score ≥2) (adjusted OR: 1.46; 95% CI: 1.16 to 1.83; p = 0.001). GHF defined in this study showed higher sensitivity to the presence of carotid plaque than other definitions of GHF.
GHF status was associated with risk of carotid plaque in individuals without history of CVD. Presence of subclinical carotid plaque was associated with risk of future CVD. Therefore, GHF based on creatinine could be a useful surrogate marker for surveillance of CVD in asymptomatic individuals.
肾小球高滤过（GHF）是肾脏的一种血流动力学变化，作为对肾单位丢失的适应性反应。尽管GHF与代谢危险因素和心血管疾病（CVD）相关，但解释这些关系的机制仍 largely 未知。这部分是由于基于病理生理血管变化的GHF定义不统一所致。因此，本研究的目的是评估健康体检队列中GHF的各种定义与颈动脉斑块之间的关联。
纳入2016年1月至2018年6月期间有颈动脉超声（USG）检查结果且无CVD病史的4493名个体。GHF定义为校正混杂因素后eGFR残差>第90百分位数。根据颈动脉USG结果计算颈动脉斑块评分。
在4493名个体（平均年龄52.3±10.1岁；3224名[71.8%]男性）中，449名受试者纳入GHF组（平均eGFR为107.0±7.1 ml/min/1.73m²），4044名受试者纳入非GHF组（平均eGFR为92.5±12.3 ml/min/1.73m²）。将GHF组与非GHF组比较时，GHF与显著颈动脉斑块（颈动脉斑块评分≥2）的存在相关（校正OR：1.46；95%CI：1.16至1.83；p = 0.001）。本研究中定义的GHF对颈动脉斑块存在的敏感性高于GHF的其他定义。
GHF状态与无CVD病史个体的颈动脉斑块风险相关。亚临床颈动脉斑块的存在与未来CVD风险相关。因此，基于肌酐的GHF可能是无症状个体CVD监测的有用替代标志物。
