Prediabetes defined by the International Expert Committee as a risk for development of glomerular hyperfiltration

Area of Science:

• Nephrology
• Endocrinology
• Metabolic Syndrome

Background:

• Glomerular hyperfiltration (GH) is an early sign of kidney damage in diabetes.
• Prediabetes is a state of impaired glucose metabolism that precedes type 2 diabetes.
• Different diagnostic criteria exist for prediabetes, potentially impacting risk assessment.

Purpose of the Study:

• To investigate whether prediabetes, as defined by the International Expert Committee (IEC) or the American Diabetes Association (ADA), is a risk factor for incident glomerular hyperfiltration (GH).

Main Methods:

• A retrospective analysis of 24,524 health examinees without diabetes, chronic kidney disease (CKD), GH, or antihypertensive treatment at baseline.
• Participants underwent at least two examinations over a mean of 5.3 years.
• Prediabetes was defined using IEC (HbA1c 42-46 mmol/mol and/or FPG 6.1-6.9 mmol/L) and ADA (HbA1c 39-46 mmol/mol and/or FPG 5.6-6.9 mmol/L) criteria. Incident GH was defined by the upper 95th percentile of estimated glomerular filtration rate (eGFR).

Main Results:

• Prediabetes defined by the IEC criteria was a significant risk factor for incident GH (adjusted HR 1.91, 95% CI 1.32-2.71).
• Prediabetes defined by the ADA criteria was not a significant risk factor for incident GH (adjusted HR 1.22, 95% CI 0.93-1.61).
• The probability of incident GH was significantly higher in the IEC prediabetes group compared to the ADA prediabetes and normal glucose regulation groups.

Conclusions:

• The International Expert Committee (IEC) definition of prediabetes is an independent risk factor for developing incident glomerular hyperfiltration (GH).
• The American Diabetes Association (ADA) definition of prediabetes may not adequately identify individuals at risk for GH.