Abstract: TH-PO982
Estimating Glomerular Filtration Rate: Is There Any Role of Including Lipids and Hemoglobin A1c (Hb A1c) in Patients with Cardiovascular Disease?
Session Information
- Physical Activity and Lifestyle in Kidney Diseases
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Author
- Ray, Madhab, University of California Davis, Davis, California, United States
Group or Team Name
- Healthy Heart Initiative Study Group.
Background
Estimation of Glomerular Filtration Rate (GFR) is a cornerstone in practice of nephrology and modern medicine. Over the last few decades, the estimation process has gone through multiple iterations with combinations of different potential predictor variables. Most commonly used CKD-Epi formula incorporates five variables: age, sex, race, body surface area and serum creatinine levels. However, there are potentially some unmeasured variables which, in a given clinical context may add predictive accuracy.
Methods
Four thousand schoolteachers were recruited in Calcutta, India for cardiovascular disease (CVD) risk assessment and evaluation of kidney function with joint approval from Tufts University IRB, Boston, and the local Ethics Committee, Calcutta. GFR was estimated with CKD-Epi model. To explore any potential unmeasured variables for GFR regression analyses were performed with traditional CVD risk factors: lipid panel for dyslipidemia and Hb A1c for diabetes mellitus.
Results
The mean age of the participants was 44 years with 41% male. Estimation of renal function with eGFR revealed most of the study population had CKD G2 (n = 125, 52%) followed by G1 and G3 (n = 53, 22% each). Six participants had CKD G3B while number of participants in G4 and G5 were one in each category.
Univariate analyses showed considerable association of GFR with total cholesterol, HDL, triglycerides and Hb A1C. A multivariable regression model showed significant association with HDL and Hb A1 C when adjusted for total cholesterol and triglycerides.
Conclusion
In patients with CVD and diabetes mellitus incorporating Hb A1 C level may potentially improve accuracy of estimated GFR by CKD-Epi model. It is important for the clinicians to remain cognizant of the possibility of inflated GFR in presence of diabetes mellitus with high Hb A1C.
Similar adjustment, although to a lesser extent, may be necessary for HDL level. While elevated HB A1 C level may increase GFR by its glycosuric effect the mechanism by which HDL may influence GFR is not entirely clear at this point.