Title:Cardiovascular Risk Related to Glomerular Hyperfiltration in Nondiabetic
Individuals: Increasing Visibility is Crucial
Volume: 19
Issue: 3
Author(s): Rodolfo Valtuille*
Affiliation:
- Diplomatura Terapias Reemplazo Renal, Universidad de Ciencias Empresariales y Sociales, Caracas 4599 C1419 EJU, Argentina
Keywords:
Golmerular filtration, cardiovascular risk, obesity, hypertension, smoking, salt, sodium-glucose cotransporter-2 inhibitors, chronic kidney disease, Non-alcoholic liver disease.
Abstract: Glomerular hyperfiltration (GHF), defined by different estimation formulas, has been
widely studied as a predictor of proteinuria and progression to chronic kidney disease (CKD) in
diabetic patients. GHF is also an important cardiovascular (CV) risk factor and is related to allcause
mortality in non-diabetic populations; however, the upper limit of glomerular filtration rate
(GFR) above which it indicates the presence of GHF is weakly defined. This higher risk is as
high as in the intermediate stages of CKD and is greater than the presence of diabetes or smoking
and is still present in non-albuminuria patients. The original Chronic Kidney Disease Epidemiology
Collaboration (CKD-EPI) estimation GFR formula showed lower error at higher glomerular
filtration (GF) values, was the most used in population studies, and behaved as a better
risk predictor. In our review (including approximately 3.6 million individuals), higher GFR values
related to increased mortality risk varied from 106.6 to 113.7 ml/min, which are usually not
considered risk values for standard guidelines in non-albuminuric patients. However, the lack of
consensus on a GF cutoff value, as well as its variability due to sex and progressive reduction
with age, affect the knowledge of this serious phenomenon in clinical practice. Although the elderly
population is not exempted from the effects of GHF, the search for this phenomenon
should be intensified in middle-aged populations because of their lower disease burden, where
this situation may be more evident, and the possibility of reversing the consequences is greater.
A population group often considered healthy includes obese people, essential hypertensives,
smokers, and carriers of fatty liver, where the GHF phenomenon is frequent and is associated
with CV disease, kidney disease, and higher mortality. Increasing its visibility by the medical
community is essential to reduce the effects of GHF, emphasizing more frequent controls and
implementing general measures that include strict control of hypertension, Na restriction, rich in
vegetables diets and increased physical activity. Initiatives to confirm the beneficial effects of
sodium-glucose cotransporter-2 inhibitors to treat isolated GHF would be an important breakthrough
in reducing the severe consequences of this phenomenon.
