Autori: G. Reboldi (1), G. Fiorucci (1), G. Quintaliani (1), P. Verdecchia (2), P. Palatini (3) on behalf of the Ambulatory Blood Pressure International (ABP-I) Database Investigators
Affiliazioni: (1) University of Perugia, Perugia, Italy; (2) Hospital of Assisi, Italy; (3) University of Padua, Italy
Background and Aim: The prognostic role of low estimated glomerular filtration rate (eGFR) is well established. In contrast, the association between greater than normal eGFR, i.e. glomerular hyperfiltration (GHF), and cardiovascular events (CVE) is much less characterized. Therefore, we sought to investigate whether GHF is independently associated with risk of adverse CV outcomes in a large multiethnic population
Patients and Methods: We recorded incident cardiovascular (CV) events in 8824 participants (55% men) aged 52±16 years recruited in 8 prospective studies worldwide (Australia, Italy, Japan, and U.S.A) with an available eGFR measurement at baseline. Using the 5th and 95th percentiles of the age and sex specific quintiles of ethnicity-adjusted eGFR calculated by the CKD-EPI formula, we identified 3 groups: low (LF), high (HF) and normal (NF) eGFR. We computed adjusted hazard ratios (HR) for CV outcome events in relation to eGFR category using Cox models stratified by center while adjusting for age, gender, smoking, diabetes, and total cholesterol.
Results: The median eGFR were: 48.2, 81.4, and 111.2 ml/min/1.73m2 for LF, NF, and HF participants, respectively. Compared with LF and NF, HF (N=426) were younger, mostly male and of white race (p<0.001). During a mean follow-up of 6.2 years, there were 722 CVE. Crude event rates were higher for both HF (1.8 per 100-person-years) and LF (2.1 per 100 person-years) as compared with NF (1.2 per 100 person-years) (p<0.001). In multivariable Cox models including age, sex, average 24-hour BP, smoking, diabetes, and cholesterol, both HF (HR 1.5, 95% CI,1.1-2.1, p=0.006) and LF (HR 2.0, 95% CI,1.5-2.6, p<0.001) participants had a higher risk of CVE as compared to NF.
Conclusions: These data show that GHF is a strong and independent predictor of CV events in a large multiethnic population. Our findings support a U-shaped relationship between eGFR categories and adverse CV outcome.
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