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. 2025 Oct 14:12:1652372.
doi: 10.3389/fnut.2025.1652372. eCollection 2025.

Renal hyperfiltration with and without metabolic syndrome: differential implications for cardiovascular events, kidney failure, and mortality

Yu Ho Lee #  1 , Dae Kyu Kim #  1 , Jin Sug Kim  1 , Su Jin Jeong  2 , Kyung Hwan Jeong  1 , Hyeon Seok Hwang  1
Affiliations

Renal hyperfiltration with and without metabolic syndrome: differential implications for cardiovascular events, kidney failure, and mortality

Yu Ho Lee et al. Front Nutr. .

Abstract

Background: Renal hyperfiltration (RHF) and metabolic syndrome (MetS) share common pathophysiology and are both associated with adverse clinical outcomes. However, their combined impact remains unclear.

Methods: In total, 278,552 propensity score-matched individuals were enrolled in the Korean National Health Insurance Service database (2009-2011). Participants were divided into four groups based on RHF and MetS status, and cardiovascular (CV) events, end-stage kidney disease (ESKD) progression, and all-cause mortality were evaluated.

Results: Compared to non-MetS with normal renal filtration (NRF), MetS with NRF was associated with a significant increase in the risk of CV events, which was further amplified when combined with RHF (adjusted HR = 1.44, 95% CI = 1.35-1.55, P for interaction = 0.047). Patients with RHF exhibited more pronounced increases in the HRs for CV events than those with NRF as the number of dysfunctional metabolic components increased (P for interaction = 0.019). The risk of ESKD progression was not increased in non-MetS with RHF; however, it was significantly higher in patients with MetS alone and highest in those with both MetS and RHF (adjusted HR = 3.23, 95% CI = 1.61-6.47). The risk of all-cause mortality was elevated in patients with RHF or MetS alone and highest in those with both RHF and MetS (adjusted HR = 1.41, 95% CI = 1.31-1.52).

Conclusion: The clinical significance of RHF differs based on MetS status, with their coexistence posing the highest risk for CV events, ESKD progression, and all-cause mortality. A synergistic interaction between RHF and MetS was evident in the risk of CV events.

Keywords: all-cause mortality; cardiovascular event; end-stage kidney disease; metabolic syndrome; renal hyperfiltration.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study participant selection. CVD, cardiovascular disease; RRT, renal replacement therapy; eGFR, estimated glomerular filtration rate; MetS, metabolic syndrome; NRF, normal renal filtration; RHF, renal hyperfiltration; CCI, Charlson comorbidity index.
Figure 2
Figure 2
Cumulative event rates for adverse clinical outcomes according to metabolic syndrome and renal hyperfiltration status. (A) Cardiovascular events, (B) progression to end-stage kidney disease, and (C) all-cause mortality. p values are calculated by log-rank test. MetS, metabolic syndrome; NRF, normal renal filtration; RHF, renal hyperfiltration.
Figure 3
Figure 3
Hazard ratios for adverse clinical outcomes based on the number of metabolic risk factors and renal hyperfiltration presence. Dots and bars indicate adjusted hazard ratios and 95% confidence intervals, respectively. (A) cardiovascular events, (B) progression to ESKD, and (C) all-cause mortality. The HRs for ESKD progression were calculated using log2-transformed values. NRF, normal renal filtration; RHF, renal hyperfiltration; HR, hazard ratio; CV, cardiovascular; ESKD, end-stage kidney disease.
See this image and copyright information in PMC

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