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Abstract: PO0997

Association of Glomerular Hyperfiltration with Glycemic Control and Serum Uric Acid Among NHANES Participants with Diagnosed Diabetes Mellitus

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Mosslemi, Mitra, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Glomerular Hyperfiltration (GH) is the earliest sign of diabetic kidney disease (DKD) even prior to the development of albuminuria. Some studies have reported that improvement in glycemic control reduces GH. Since elevated serum uric acid (SUA) level may herald worse diabetes outcomes including a higher likelihood of DKD, we sought to examine the association of GH status with glycemic control and SUA among diabetics.

Methods

We examined the National Health and Nutritional Examination Survey (NHANES) data from 1999 through 2016, comprising adults (age 20 years, n= 47,133, projected to N=214.9 million US population). We defined diagnosed diabetes cases as those who reported being diagnosed by a doctor or using glucose-lowering medications (n= 5,783, N=19.3M) and defined GH as eGFR 120 ml/min/1.73m2 (CKD-EPI) vs. normal-filtration as 60 ≤ eGFR <120 (GH: n=110, non-GH: n=3115). Cases with eGFR<60 were excluded (n= 2,558). We assessed the association of GH with average glycemic control (HbA1c) and SUA levels adjusted for demographic characteristics, diabetes duration, and diabetes treatment, using univariate and multivariable regression models.

Results

The prevalence of GH in persons under 10 years of diabetes was 2.7% but significantly less after 10 years (1.1%, p= 0.003). GH was more likely in younger age, female sex, Hispanic ethnicity, higher A1c, higher SUA, and those with no diabetes treatment. In the multivariable model, female sex was the strongest predictor followed by Hispanic ethnicity, higher SUA, and younger age [Table].

Conclusion

GH is more common in the first 10 years of diabetes and associated with higher SUA. It is more common among females, Hispanic race, and younger diabetes patients. Further studies should examine the potential role of sex, ethnicity, age, and SUA in the mechanism of GH among persons with diabetes.

Regression model for variables associated with Glomerular Hyperfiltration (GH) among patients with diagnosed diabetes
VariablesOdds Ratio (95% CI)P-Value
Age (per SD)0.91 (0.89, 0.92)<0.0001
Gender (Female vs. Male)16.34 (5.10, 52.34)<0.0001
Ethnicity (Hispanic vs. White)3.10 (1.39, 6.90)0.006
HbA1c (per SD)1.01 (1.00, 1.02)0.06
SUA (Hypouricemia vs. Reference)2.28 (1.13, 4.62)0.02