The ePREDICE trial explored the prevalence and factors contributing to kidney abnormalities in individuals with prediabetes (PD). This sub-analysis examined 967 participants from seven countries, assessing renal function using the MDRD-4 equation and albumin-to-creatinine ratio (ACR). The study identified glomerular hyperfiltration, albuminuria, and reduced kidney function as indicators of renal involvement.

      Key findings revealed that 9.2% of participants had renal abnormalities, including hyperfiltration (2%), albuminuria (4.7%), and CKD stage G3a (3%). Hyperfiltration was predominantly observed in younger participants and women, with significant associations with markers such as lower serum creatinine and uric acid. Albuminuria was linked to impaired insulin signaling, reflected by a lower disposition index (DI), while reduced kidney function correlated with older age and higher waist circumference.

      Multivariable regression highlighted the complex interactions between clinical, biochemical, and metabolic factors influencing renal involvement. Age emerged as a significant determinant, with an estimated 5% higher risk of reduced kidney function per additional year. Waist circumference also showed a strong association with decreased eGFR. Interestingly, liver enzymes like gamma-glutamyltransferase (GGT) were inversely associated with kidney function, emphasizing the metabolic interplay between liver and kidney health.

      The study underscores the importance of early detection of renal abnormalities in individuals with prediabetes, especially those with advanced age or metabolic risk factors. It also highlights the need for targeted screening and interventions to mitigate the progression of kidney damage. Although limited by its cross-sectional design and small sample size in certain subgroups, the findings provide valuable insights into the early signs of renal impairment in PD.

      Future research should focus on longitudinal studies to understand the progression of kidney dysfunction in prediabetes and explore the effectiveness of interventions aimed at preserving renal health. The ePREDICE trial emphasizes the critical need for proactive management in this population to prevent chronic kidney disease and related complications.