The Relationship between Prediabetes and Glomerular Hyperfiltration among Middle-Aged and Elderly Adults in Taiwan

  • 孫 子傑

Student thesis: Master's Thesis


Background: The prevalence of chronic kidney disease (CKD) in Taiwan is up to 11 93% especially among middle-aged and elderly adults Glomerular hyperfiltration (GHF) often appears in early diabetes and is associated with the occurrence of subsequent nephropathy However only a few studies reported inconsistent results regarding the relationship between prediabetes and GHF Therefore the aim of this study is to clarify the relationship between prediabetes and GHF Methods: This study used a secondary data without personal ID including the examinees who undertook health examinations in National Cheng Kung University Hospital between January 2000 and August 2009 We included those aged 40 or over with complete data and excluded those with renal diseases cancer anti-hypertensive medications cardiovascular medications anti-diabetic medications and diabetic history Finally 9616 subjects entered into the analyses The estimated glomerular filtration rate (eGFR) was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula Hyperfiltration was defined as eGFR above the age- and sex-specific 95th percentile for healthy subjects According to the 2010 criteria of American Diabetes Association prediabetes was diagnosed when fasting plasma glucose was 100 mg/dL to 125 mg/dL (impaired fasting glucose IFG) two-hour plasma glucose in the 75-g oral glucose tolerance test was 140 mg/dL to 199 mg/dL (impaired glucose tolerance IGT) or Hemoglobin A1c (HbA1c) was between 5 7 and 6 4% Multiple linear and multinomial logistic regression analyses with backward selection were performed with considering demographic biological psychological and behavior variables Results: The proportions of hyperfiltration increased with increased glycemic status Multiple linear regression analyses showed that there was a positive and significant association between fasting glucose and eGFR (β =0 027 p =0 002) Other positively associated variables included education (1-6 years) and current alcohol drinking Age male gender total cholesterol HDL cholesterol uric acid regular exercise and depression were inversely associated with eGFR Multiple logistic regressions showed that prediabetes except IGT and newly diagnosed diabetes were both associated with the risk of hyperfiltration after adjustment for other variables Combined IFG&IGT had the similar risk of hyperfiltration (adjusted OR: 1 74 95%CI: 1 17–2 58) with newly diagnosed diabetes Conclusions: Fasting glucose was positively associated with eGFR and prediabetes was associated with the risk of hyperfiltation In particular combined IFG&IGT had the similar risk of hyperfiltration with newly diagnosed diabetes Therefore renal function may need to be monitored actively in subjects with prediabetes especially with combined IGT&IFG and earlier treatment of hyperglycemia is necessary to prevent the development of nephropathy once hyperfiltration appears
Date of Award2014 Sep 1
Original languageEnglish
SupervisorFeng-Hwa Lu (Supervisor)

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