Glomerular hyperfiltration associated with high metabolic risk
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The metabolic syndrome phenotype is associated with increased risk for chronic kidney disease, part of the latter being ascribed to well-identified risk factors, such as diabetes mellitus and/or high blood pressure. Some components (e.g. obesity and hyperglycaemia) of the phenotype are also associated with risk of developing glomerular hyperfiltration. To investigate the early associations between renal dysfunction and metabolic syndrome, a total of 1572 apparently healthy young men were phenotyped for metabolic risk factors whilst their creatinine clearance was estimated by the Cockcroft-Gault formula. High metabolic risk defined by the clustering of at least three metabolic risk factors was detected in 8.7% of the subjects. When compared to reference (none to two metabolic risk factors), subjects with high metabolic risk had a 6.9-fold increase in the odds of glomerular hyperfiltration. The multivariate-adjusted odds ratio of glomerular hyperfiltration was increased by overweight to 6.6, by elevated blood pressure to 1.8 and by low HDL-cholesterol to 2.5. In factor analysis, systolic and diastolic blood pressures clustered together with leptin. This blood pressure-adiposity cluster significantly (P<0.0001) correlated with estimated creatinine clearance, explaining on its own 10.2% of the variance in estimated renal function. In conclusion, high metabolic risk appears associated with glomerular hyperfiltration prior to overt manifestations of cardiovascular disease.
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