Abstract: FR-PO1146
Effect of Hyperfiltration on the Kidneys and the Triglyceride (TG)-to-HDL Cholesterol (HDL-C) Ratio in Nondiabetic Individuals
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Author
- Araki, Makoto, Sapporo Tokushukai Byoin, Sapporo, Hokkaido Prefecture, Japan
Background
The rise of the cardio-renal-metabolic syndrome concept and broader use of SGLT2 inhibitors in non-diabetics mark a shift toward earlier intervention in kidney care. We conducted a study to assess whether glomerular hyperfiltration (GHF) or hyperinsulinemia, estimated by the TG/HDL-C ratio (TGR), more strongly predicts renal function decline in this population.
Methods
This single-center observational study included individuals aged ≥18 years who underwent annual health checkups with serum creatinine measurements from 2012 to 2024. Participants were stratified by age and sex; strata with ≥200 subjects were included. GHF was defined as estimated glomerular filtration rate (eGFR) above the 95th percentile within each stratum; controls were those with eGFR >60 mL/min/1.73 m2 excluding GHF. The index date was the first checkup with GHF or the initial checkup during the study for controls. Hyperinsulinemia was estimated using TGR (cut-off: 2.1), and subjects were stratified into high and low TGR groups. Exclusion criteria were age <18, missing TG/HDL-C values, or HbA1c ≥6.5%. The primary outcome was time to a 30% eGFR decline, analyzed by Kaplan-Meier curves and Cox proportional hazards models.
Results
A total of 5,654 individuals (mean age 48.7 years; 48.8% male; mean eGFR 79.0) were analyzed. GHF was observed in 611 subjects (mean eGFR 102.3), and 1,615 were categorized as high TGR. During follow-up, 183 participants (3.2%) experienced ≥30% eGFR decline. Kaplan-Meier analysis, adjusted for age and sex, showed significantly higher risk in the GHF group vs controls (log-rank p<0.001), while no significant difference was observed between high and low TGR groups (p=0.7). Cox regression showed a markedly elevated risk with GHF, while high TGR alone showed no significant association (Figure).
Conclusion
GHF significantly increased renal risk regardless of TGR, while elevated TGR alone was not associated with additional risk. These findings suggest hyperfiltration is a dominant factor in renal decline among non-diabetic individuals, whereas surrogate hyperinsulinemia markers contribute little.