Kyung Don Yoo1, Hyung-Jin Yoon2, Seung-Sik Hwang3, Nam Ju Heo4, Ho Jun Chin5,6, Seung Hee Yang6, Kwon Wook Joo6,7, Yon Su Kim6,7, Hajeong Lee6,7. 1. Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Korea. 2. Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Korea. 4. Department of Internal Medicine, Healthcare System Gangnam Center Seoul National University Hospital, Seoul, Korea. 5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 6. Kidney Research Institute, Seoul National University Hospital, Seoul, Korea. 7. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Abstract
AIM: Renal hyperfiltration (RHF) is a marker of early kidney injury that was recently shown to be a novel marker of mortality. However, it has no clear definition. In this study, we suggested an age- and sex-adjusted RHF definition and explored the association between RHF and mortality by sex. METHODS: We analyzed data from individuals receiving routine health examinations from 1995 to 2009. RHF was defined as an estimated glomerular filtration rate over the 95th percentile matched for age and sex. RESULTS: A total of 114 966 individuals were included. During the 75-month of observation period, 2559 (2.2%) participants died. Among those, 71.4% were men. Because sex and RHF had a significant interaction for mortality (P for interaction < 0.001), we performed survival analysis according to sex. RHF was related to lower body weight and a higher proportion of cigarette smoking in men, whereas these relationships were not found in women. In the Kaplan-Meier curve, RHF was associated with higher mortality rate than non-RHF in both sexes, but this relationship was more prominent in men. In the multivariate analysis, RHF remained as an independent risk factor for all-cause mortality even after adjustment for confounding in men (hazard ratio, 1.34; 95% confidence interval, 1.12-1.59; P = 0.001). In women, RHF was not associated with increased mortality. CONCLUSIONS: We demonstrated that RHF was a significant risk factor for mortality in men but not in women. The mechanisms and clinical implications of these different associations according to sex require a further clarification.
AIM: Renal hyperfiltration (RHF) is a marker of early kidney injury that was recently shown to be a novel marker of mortality. However, it has no clear definition. In this study, we suggested an age- and sex-adjusted RHF definition and explored the association between RHF and mortality by sex. METHODS: We analyzed data from individuals receiving routine health examinations from 1995 to 2009. RHF was defined as an estimated glomerular filtration rate over the 95th percentile matched for age and sex. RESULTS: A total of 114 966 individuals were included. During the 75-month of observation period, 2559 (2.2%) participants died. Among those, 71.4% were men. Because sex and RHF had a significant interaction for mortality (P for interaction < 0.001), we performed survival analysis according to sex. RHF was related to lower body weight and a higher proportion of cigarette smoking in men, whereas these relationships were not found in women. In the Kaplan-Meier curve, RHF was associated with higher mortality rate than non-RHF in both sexes, but this relationship was more prominent in men. In the multivariate analysis, RHF remained as an independent risk factor for all-cause mortality even after adjustment for confounding in men (hazard ratio, 1.34; 95% confidence interval, 1.12-1.59; P = 0.001). In women, RHF was not associated with increased mortality. CONCLUSIONS: We demonstrated that RHF was a significant risk factor for mortality in men but not in women. The mechanisms and clinical implications of these different associations according to sex require a further clarification.
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