RENAL hyperfiltration dynamics were associated with distinct risks of mortality and cardiovascular events in a nationwide cohort study of more than one million Korean individuals, highlighting the potential value of tracking changes in kidney filtration over time for cardiovascular risk stratification.
Renal hyperfiltration (RHF), characterised by an estimated glomerular filtration rate (eGFR) above the 95th percentile after multiple adjustments, has been linked to adverse clinical outcomes. However, RHF can emerge or resolve over time, and the prognostic implications of these changes remain unclear.
The nationwide cohort study included 1,022,062 individuals of Korean ethnicity who underwent consecutive health screening examinations between 2012 and 2015. Researchers classified participants into four groups according to changes in RHF status: RHF free, newly developed RHF, disappeared RHF, and persistent RHF.
The investigators assessed the associations between these patterns and subsequent mortality and cardiovascular (CV) events to determine whether the duration and trajectory of hyperfiltration were relevant to clinical outcomes.
Compared with individuals who remained RHF free, participants with persistent RHF experienced the highest observed risks of mortality and CV events. The adjusted hazard ratio for mortality was 1.61 (95% confidence interval: 1.24–2.10), while the adjusted hazard ratio for CV events was 1.39 (95% confidence interval: 1.13–1.71).
Mortality risk was also elevated across the other RHF transition patterns, irrespective of how long hyperfiltration was present or the slope of excess hyperfiltration. These findings indicated that mortality associations extended beyond individuals with persistent RHF.
However, the relationship between RHF transitions and CV outcomes differed. Increased CV risk was observed primarily among individuals whose RHF subsequently disappeared, as well as those with persistent RHF. No corresponding increase was reported among individuals who developed RHF during the study period.
Among individuals whose RHF disappeared, CV risk was particularly associated with longer exposure to RHF and a declining slope of excess hyperfiltration. This suggests that the transition away from hyperfiltration may carry prognostic information that differs from the development of the condition.
The findings highlight the importance of distinguishing between RHF transition patterns when examining associations with mortality and CV events. Persistent RHF was associated with elevated risks for both outcomes, while the disappearance of RHF was also associated with increased CV risk.
Although the observational findings do not establish causality or demonstrate the clinical effectiveness of RHF monitoring as a risk prediction tool, they support further investigation into the prognostic value of longitudinal kidney filtration measurements. Understanding how RHF develops, persists, or resolves may help refine future approaches to cardiovascular risk stratification.
Reference
Kim JS et al. Renal hyperfiltration dynamics as a cardiovascular risk stratification marker. Sci Rep. 2026;DOI:10.1038/s41598-026-76649-9.
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