Objectives. To estimate the prevalence of decreased kidney function in an elderly population and to evaluate the impact of using alternative markers of glomerular filtration rate (GFR), focusing on serum cystatin C (Cys C) and the Modification of Diet in Renal Disease (MDRD) Study prediction equation. Design and methods. In a cross-sectional community-based survey renal function was assessed by serum creatinine (SCreat), Cys C and GFR predicted by the Cockcroft-Gault (CG) and the MDRD Study formulae. Associations with age, gender and proteinuria were analysed by linear models. Subjects. A total of 1246 elderly residents in Lieto, Finland, 64-100 years of age.Results. The prevalence of moderately or severely decreased renal function, estimated by the MDRD Study equation, was 35.7%; the CG formula yielded 58.6%. The profile of Cys C performance, including variation across age groups and level of health status, showed greater similarity to GFR estimated using the MDRD Study equation than to SCreat alone, or GFR estimated using the CG formula. Discordance between high Cys C levels and only mildly decreased GFR estimates was observed in subjects with functional limitations. Microalbuminuria was associated with Cys C levels only (P ¼ 0.047). Conclusion. Prevalence estimates of decreased renal function amongst the elderly vary considerably depending on prediction formula used. Variation in creatinine metabolism amongst elderly comorbid patients and the critical dependence on the SCreat assay and exact calibration, make the use of creatinine-based formulae to predict GFR questionable in geriatric clinical practice. In this setting, Cys C is a promising alternative.

No abstract

The effects of 4 months' physical exercise on the metabolic control in non‐insulin‐dependent diabetes were studied in 25 patients divided randomly into exercise (n=13) and control (n=12) groups. In the exercise group glycosylated hemoglobin A1 fell from 9.6–8.6% (p<0.01) and the 2 hour plasma glucose in oral glucose tolerance test decreased from 19.7–16.5 mmol/l (p<0.01). The mean fall in fasting plasma glucose from 11.8–10.5 mmol/l was not statistically significant. The responses of plasma insulin and C‐peptide to oral glucose increased significantly during the exercise period. However, patients with initially poorest metabolic control were not able to improve their physical fitness and did not show significant improvement in metabolic control. In the control group no changes occurred in any parameter of glucose metabolism. The results suggest that physical exercise is beneficial for the glycemic control in patients with mild and moderate non‐insulin‐dependent diabetes. Increased insulin response is at least one main mechanism of the action of exercise.

OBJECTIVE -To characterize renal impairment associated with diabetes in older adults by serum markers of glomerular filtration rate and microalbuminuria tests. RESEARCH DESIGN AND METHODS -The study population consisted of 187 diabetic and 1,073 nondiabetic subjects (age range 64 -100 years) participating in a crosssectional, population-based survey in southwestern Finland. Renal function was estimated by serum cystatin C (Cys C), serum creatinine (Cr), and the urinary albumin-to-creatinine ratio, and determinants of elevated levels were assessed by multivariate analysis.RESULTS -Diabetes, compared to hypertension, was a more powerful determinant of elevated Cys C and Cr levels in the very old (age Ն80 years), whereas the impact of hypertension was more pronounced in the younger group (age Ͻ80 years). The prevalence of microalbuminuria among diabetic subjects was 29.7%, and 15% had elevated Cr levels, whereas the prevalence of elevated Cys C levels varied considerably depending on whether adult or age-adjusted reference limits were used (64.7 vs. 21.4%). In 64.1% of diabetic subjects with elevated Cys C levels based on age-adjusted reference limits and in 48.2% of subjects with elevated Cr levels, microalbuminuria was absent.CONCLUSIONS -The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people. The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research. Diabetes Care 27:2648 -2653, 2004O ver the past decade there has been considerable interest in the increasing incidence of diabetic nephropathy, predominantly in patients with type 2 diabetes (1). As the treatment of cardiovascular diseases has improved, diabetic nephropathy is increasingly becoming a disease of older people (2). However, our understanding of diabetic nephropathy is primarily based on research done among middle-aged populations, and direct extrapolation of these results to the elderly, especially to the very old, may be inappropriate.Screening for microalbuminuria, the earliest manifestation of diabetic nephropathy, is recommended for all diabetic patients (3). However, much of the knowledge about diabetic nephropathy is derived from studies concerning type 1 diabetes, while kidney disease in type 2 diabetes may be more heterogeneous and not necessarily manifested as classic diabetic glomerulosclerosis and albuminuria. It has been suggested that clinicians, in addition to monitoring urine albumin excretion, should assess glomerular filtration rate (GFR) to screen for renal disease among patients with type 2 diabetes (4).Serum creatinine (Cr) is the most widely used marker of GFR in the office setting, although it is an insensitive measure of early renal disease (5). Serum cystatin C (Cys C), a low-molecular weight...

No abstract