Causes of low gfr in adults
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Causes of Low Glomerular Filtration Rate (GFR) in Adults
Hypertension and Prehypertension
Hypertension and prehypertension are significant predictors of decreased GFR in adults. Studies have shown that individuals with hypertension (BP >140/90 mmHg) and prehypertension (systolic BP of 120-139 and/or diastolic BP of 80-89 mmHg) are at a higher risk of developing decreased GFR. Specifically, the relative risks (RR) for decreased GFR are 1.76 for hypertension and 1.19 for prehypertension. Additionally, every 10-mm Hg increase in systolic and diastolic BP is associated with higher risks for decreased GFR.
Low Birth Weight and Nephron Number
Adults born with a low birth weight often have a reduced number of nephrons, which can lead to a lower GFR. This condition is associated with higher blood pressure and an increased albumin-to-creatinine ratio in early adulthood, further contributing to decreased kidney function.
Diabetes and Rapid GFR Decline
In individuals with Type 1 diabetes, rapid GFR decline is a recognized predictor of impaired GFR. Renal hyperfiltration (eGFR ≥ 120 mL/min/1.73 m²) is a significant predictor of rapid GFR decline, which in turn predicts incident impaired GFR. This suggests that rapid GFR decline plays an intermediate and predictive role in the progression of diabetic nephropathy.
Adiposity and Obesity
Elevated body mass index (BMI), waist circumference, and waist-to-height ratio are independent risk factors for GFR decline. Higher levels of adiposity are associated with a greater risk of GFR decline, with hazard ratios increasing with higher BMI levels. This relationship holds true across various subgroups, including those with normal and reduced levels of estimated GFR.
Chronic Kidney Disease (CKD) and Aging
Chronic kidney disease (CKD) is a common cause of low GFR, and its prevalence increases with age. The current criteria for CKD diagnosis include a GFR below 60 ml/min per 1.73 m², but this threshold does not account for the natural decline in GFR with aging. Studies suggest that the GFR threshold for increased mortality risk varies with age, being higher in younger individuals and lower in the elderly. This indicates the need for age-specific thresholds in CKD diagnosis to avoid misclassification and inappropriate care.
Cardiovascular Disease and Albuminuria
Decreased GFR and albuminuria are both predictors of cardiovascular and all-cause mortality. Lower GFR is associated with higher risks of cardiovascular and all-cause mortality, and this risk is compounded when albuminuria is present. This highlights the importance of monitoring both GFR and albuminuria in assessing the overall health and mortality risk in adults.
Conclusion
Low GFR in adults can be attributed to a variety of factors, including hypertension, low birth weight, diabetes, obesity, aging, and cardiovascular disease. Understanding these causes is crucial for early detection and management of decreased kidney function, ultimately improving patient outcomes and reducing the burden of chronic kidney disease.
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