Cardiovascular implications of glomerular filtration rate alterations beyond conventional chronic kidney disease...

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) is a global health issue linked to cardiovascular disease (CVD) and mortality.
• Glomerular filtration rate (GFR) abnormalities, including glomerular hyperfiltration (GHF) and selective glomerular hypofiltration syndrome (SHS), are implicated in CKD progression and CVD.
• Chronic inflammation is a central mechanism connecting GFR abnormalities to systemic complications and CVD.

Purpose of the Study:

• To highlight the significance of GFR abnormalities (GHF and SHS) in the context of CKD and CVD.
• To emphasize the role of chronic inflammation in GHF and SHS-driven pathologies.
• To discuss the diagnostic challenges and potential improvements in GFR assessment.

Main Methods:

• Review of current understanding of GHF and SHS in relation to CKD and CVD.
• Analysis of the impact of GHF and SHS on endothelial dysfunction, albuminuria, and systemic inflammation.
• Evaluation of different estimated GFR (eGFR) methods, including those using cystatin C (Cys C) and creatinine (Cr).

Main Results:

• GHF, prevalent in obesity, diabetes, and metabolic syndrome, is associated with endothelial dysfunction, CKD progression, and albuminuria.
• SHS leads to proteomic alterations and retention of pro-inflammatory molecules, exacerbating atherosclerosis and endothelial dysfunction.
• Cys C-based and Cr-based eGFR formulas show superior predictive value for risk and detection of GFR abnormalities compared to other methods.

Conclusions:

• GHF and SHS are critical GFR abnormalities that contribute significantly to CKD and CVD.
• Accurate GFR assessment using improved biomarkers is essential for early identification and management.
• Expanding the CKD paradigm to include these GFR alterations and adopting multidisciplinary approaches may reduce CVD burden and improve patient outcomes.