Dataset Information

The Error of Estimated GFR in Type 2 Diabetes Mellitus.

ABSTRACT: Type 2 diabetes mellitus represents 30-50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtration rate in diabetic patients. We evaluated the error of creatinine and/or cystatin-C based formulas in reflecting real renal function over a wide range of glomerular filtration rate (from advanced chronic kidney disease to hyperfiltration). The error of estimated glomerular filtration rate by any equation was common and wide averaging 30% of real renal function, and larger in patients with measured glomerular filtration rate below 60 mL/min. This led to chronic kidney disease stages misclassification in about 30% of the individuals and failed to detect 25% of the cases with hyperfiltration. Cystatin-C based formulas did not outperform creatinine based equations, and the reliability of more modern algorithms proved to be as poor as older equations. Formulas failed in reflecting renal function in type 2 diabetes mellitus. Caution is needed with the use of these formulas in patients with diabetes, a population at high risk for kidney disease. Whenever possible, the use of a gold standard method to measure renal function is recommended.

SUBMITTER: Luis-Lima S

PROVIDER: S-EPMC6832380 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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The Error of Estimated GFR in Type 2 Diabetes Mellitus.

Luis-Lima Sergio S Higueras Linares Tomás T Henríquez-Gómez Laura L Alonso-Pescoso Raquel R Jimenez Angeles A López-Hijazo Asunción María AM Negrín-Mena Natalia N Martín Candelaria C Sánchez-Gallego Macarena M Galindo-Hernández Sara Judith SJ Socas Fernández Del Castillo Raquel R Castilla-Marrero Manuel M Domínguez-Coello Santiago S Vilchez de León Vanesa V Valcárcel-Lopez Rafael R Insausti-Garmendia Nerea N Escamilla Beatriz B Estupiñán Sara S Delgado-Mallén Patricia P Armas-Padrón Ana-María AM Marrero-Miranda Domingo D González-Rinne Ana A Miquel Rodríguez Rosa María RM Cobo-Caso María Angeles MA Díaz-Martín Laura L González-Rinne Federico F González-Delgado Alejandra A López-Martínez Marina M Jiménez-Sosa Alejandro A Torres Armando A Porrini Esteban E

Journal of clinical medicine 20190926 10

Type 2 diabetes mellitus represents 30-50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtrati ...[more]

PMID: 31561432

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Project description:BACKGROUND:Several reviews have recently detailed the beneficial effects of weight loss surgery for kidney function. However, these studies have a number of limitations, including small sample size, few done in chronic kidney disease (CKD) stages 3 and 4, and many not including the main bariatric surgery procedures used in the United States today. STUDY DESIGN:This was an observational retrospective cohort study comparing propensity score-matched bariatric surgery patients and nonsurgery control patients who were referred for, but did not have, surgery. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy were also compared using propensity matching. SETTING & PARTICIPANTS:Patients (714 surgery patients; 714 controls) were from a large integrated health care system, a mean of 58±8 (SD) years old, and mostly women (77%) and non-Hispanic whites (56%) and had diabetes mellitus (66%) and/or hypertension (91%). PREDICTOR:Predictors at the time of surgery or referral to surgery were age, sex, race/ethnicity, weight, and presence of diabetes and/or hypertension. OUTCOMES:The primary outcome for this study was change in estimated glomerular filtration rate (eGFR) from serum creatinine level over a median 3-year follow-up period. MEASUREMENTS:Serum creatinine was used to calculate eGFR using the CKD-EPI (CKD Epidemiology Collaboration) creatinine equation. RESULTS:Surgery patients had 9.84 (95% CI, 8.05-11.62) mL/min/1.73m2 greater eGFRs than controls at a median 3 years' follow-up and RYGB patients had 6.60 (95% CI, 3.42-9.78) mL/min/1.73m2 greater eGFRs than sleeve gastrectomy patients during the same period. LIMITATIONS:This study is limited by its nonrandomized observational study design, estimation of GFR, and large changes in muscle mass, which may affect serum creatinine level independent of changes in kidney function. CONCLUSIONS:Bariatric surgery, especially the RYGB procedure, results in significant improvements for up to 3 years in eGFRs for patients with CKD stages 3 and 4.

Dataset Information

The Error of Estimated GFR in Type 2 Diabetes Mellitus.

Publications

The Error of Estimated GFR in Type 2 Diabetes Mellitus.

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