Are prediction equations for glomerular filtration rate useful for the long-term monitoring of type 2 diabetic patients?

Fontseré, Néstor; Salinas, Isabel; Bonal, Jordi; Bayés, Beatriz; Riba, Joaquim; Torres, Ferrán; Ríos, José; Sanmartí, Ana; Romero, R.

doi:10.1093/ndt/gfl221

Cited by 69 publications

(49 citation statements)

References 15 publications

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“…We found no significant improvement in prediction by using the reexpressed MDRD equation. The better value of the MDRD equation at more advanced CKD stages reported elsewhere (11) was not unexpected, as MDRD equation performance improves when GFR declines. The absence of bias according to the GFR level is an obvious advantage for determining CKD progression with Cys-eGFR.…”

Section: Prediction Of Ckd Progressionsupporting

confidence: 56%

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New Predictive Equations Improve Monitoring of Kidney Function in Patients With Diabetes

et al. 2007

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OBJECTIVE -The Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations poorly predict glomerular filtration rate (GFR) decline in diabetic patients. We sought to discover whether new equations based on serum creatinine (the Mayo Clinic Quadratic [MCQ] or reexpressed MDRD equations) or four cystatin C-based equations (glomerular filtration rate estimated via cystatin formula [Cys-eGFR]) were less biased and better predicted GFR changes.RESEARCH DESIGN AND METHODS -In 124 diabetic patients with a large range of isotopic GFR (iGFR) (56.1 Ϯ 35.3 ml/min per 1.73 m 2 [range 5-164]), we compared the performances of the equations before and after categorization in GFR tertiles. A total of 20 patients had a second determination 2 years later.RESULTS -The Cockcroft-Gault equation was the least precise. The MDRD equation was the most precise but the most biased according to the Bland-Altman procedure. By contrast with the MDRD and, to a lesser extent, the MCQ, three of the four Cys-eGFRs were not biased. All equations overestimated the low GFRs, whereas only the MDRD and Rule's Cys-eGFR equations underestimated the high GFRs. For the subjects studied twice, iGFR changed by Ϫ8.5 Ϯ 17.9 ml/min per 1.73 m 2 . GFR changes estimated by the Cockcroft-Gault (Ϫ4.5 Ϯ 6.8) and MDRD (Ϫ5.7 Ϯ 6.2) equations did not correlate with the isotopic changes, whereas new equationpredicted changes did: MCQ: Ϫ8.7 Ϯ 9.4 (r ϭ 0.44, P Ͻ 0.05) and all four Cys-eGFRs: Ϫ6.2 Ϯ 7.4 to Ϫ7.3 Ϯ 8.4 (r ϭ 0.60 to 0.62, all P Ͻ 0.005), such as 100/cystatin-C (r ϭ 0.61, P Ͻ 0.005). CONCLUSIONS -The new predictive equations better estimate GFR than the CockcroftGault equation. Although the MDRD equation remains the most accurate, it poorly predicts GFR decline, as it overestimates low and underestimates high GFRs. This bias is lesser with the MCQ and Cys-eGFR equations, so they better predict GFR changes. 30:1988-1994, 2007 C hronic kidney disease (CKD) is a major health problem worldwide, with dramatically rising incidence and prevalence. Patients with diabetes are particularly affected by this negative development. It is necessary to stratify CKD and estimate its progression because diabetes is the leading cause of end-stage renal disease (1). The National Kidney Foundation guidelines recommend estimating glomerular filtration rate (GFR) in subjects with CKD (2). According to the National Kidney Foundation and the American Diabetes Association, GFR can be estimated in adults by using the Cockcroft-Gault or the Modification of Diet in Renal Disease (MDRD) equations (1,3). Neither of these equations, based on serum creatinine, is highly predictive of GFR. The Cockcroft-Gault equation is less accurate (4), biased by body weight (5), and less robust in patients with poor glycemic control (6). The simplified MDRD equation allows renal function to be classified with acceptable precision and requires only usual information about the patient. However, adjustment may be required to avoid error due to creatinine assays and calibrators (7). Moreov...

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Section: Prediction Of Ckd Progressionsupporting

confidence: 56%

“…Their precision seems even worse for estimating CKD progression, leading to unacceptable inaccuracy (10). The estimated equations reflected the measured GFR decline only in the most advanced (Kidney Disease Outcomes Quality Initiative stage 3) cases (11), suggesting that variable predictive performance due to GFR level may play a role in this imprecision.…”

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confidence: 99%

New Predictive Equations Improve Monitoring of Kidney Function in Patients With Diabetes

et al. 2007

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“…This is especially true with high GFR values or high filtration fraction (18). Both the Modification of Diet in Renal Disease Study and the Cockcroft-Gault formulas systematically underestimate GFR, especially at high levels (.60 ml/min per 1.73 m 2 ), which might particularly compromise their suitability in patients with incipient kidney disease and hyperfiltration (19). In contrast, the CKD Epidemiology Collaboration equation might be a superior surrogate marker of GFR in patients with hyperfiltration (20,21).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Cachat

Combescure

Cauderay³

et al. 2015

Clinical Journal of the American Society of Nephrology

155

138

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Background and objectives Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature.Design, setting, participants, & measurements Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms "hyperfiltration" or "glomerular hyperfiltration". All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included.Results The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P,0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P,0.001); the threshold did not differ among pediatric, adult, or mixedage studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m 2 (median, 135 ml/min per 1.73 m 2 ).Conclusion Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age-and sex-matched control group should be used to define a GH threshold.

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“…Prema podacima iz literature veći stepen anemije se javlja kod dijabetičara u ranijim stadijumina HBI nego kod nedijabetičara, a korekcija je teža i sporija. Postoje podaci da je nizak nivo hemoglobina povezan sa pojavom mikroangiopatija (retinopatija i nefropatija) [18]. Zbog toga se preporučuje rano započeti liječenje bubrežne anemije kod ovih bolesnika.…”

Section: Diskusijaunclassified

Uticaj korekcije anemije bolesnika sa hroničnom bubrežnom insuficijencijom na kardiovaskularni sistem

Radović¹,

Kešelj²,

Pejović³

2011

Biomedicinska istraž.

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Kratak sadržajUvod. Anemija je česta komplikacija hronične bubrežne insuficijencije, a njen glavni uzrok je nedovoljno stvaranje eritropoetina. Anemija predstavlja značajan faktor rizika za nastanak kardiovaskularnih bolesti. Cilj rada je bio da se ispita oporavak anemije tokom primjene humanog rekombinovanog eritropoetina kod bolesnika sa hroničnom bubrežnom insuficijencijom u predijaliznom periodu i uticaj korekcije anemije na kardiovaskularne promjene.Metode. U prospektivnoj studiji praćeno je 20 bolesnika (13 muškaraca i sedam žena) sa hroničnom bubrežnom insuficijencijom u predijaliznoj fazi tokom jedne godine. Bolesnici su podijeljeni u tri grupe prema jačini glomerulske filtracije (JGF) i u dvije podgrupe -bolesnici sa i bez dijabetesa. JGF je procjenjena pomoću Cockroft-Gault formule. Težina anemije određivana je na osnovu vrijednosti hemoglobina i hematokrita. Kardiovaskularni status je praćen EKG i EHO pregledima srca na početku studije i poslije godinu dana. Statistička obrada rađena je primjenom Studentov-og t-test, analize varijanse, Pearson-ovog koeficijenta korelacija uz korišćenje programa SPSS 12.Rezultati. Prije započinjanja liječenja anemije kod svih bolesnika vrijednosti hemoglobina (Hb) i hematokrita (Hct) su ukazivale na težak stepen anemije. Bolesnicima je ordiniran eritropoetin-beta. Poslije mjesec dana liječenja kod svih je došlo do statistički značajnog porasta Hb i Hct, a poslije tri mjeseca postignuta je ciljna vrijednost Hb i Hct. U ispitanoj grupi bolesnika, svi su sem jednog, imali značajnu hipertofiju lijeve komore koja je utvđena ehosonografski prije početka ispitivanja. Poslije godinu dana liječenja anemije postignuta je statistički značajna regresija mase lijeve komore (MLK) od 267,2g/m 2 do 212,5g/m 2 pri prosječnoj promjeni koncentracije Hb od 9 g/l na 12,5 g /dl. Kod bolesnika koji nisu imali dijabetes, prosječan Hb bio je 8,9 g /dl i povećao se na 12,2g /dl, a prosječna MLK se smanjila od 293,3 g/1,73 m 2 na 222,9 g/1,73 m 2 , dok je kod dijabetičara prosječna vrijednost Hb porasla sa 9,0 g / dl na 12,6 g /dl, a MLK se smanjila od 231,1 g/1,73 m 2 do 198,1 g/1,73 m 2 .Zaključak. Liječenje eritropoetinom u predijaliznom periodu omogućilo je statistički visoko značajnu korekciju anemije. Oporavak anemije pratilo je smanjenje hipertrofije lijeve komore, smanjenje manifestacija ishemije srca i normalizacija EKG nalaza.Ključne riječi: hronična bubrežna insuficijencija, anemija , eritropoetin, hipertrofija lijeve komore.

show abstract

Are prediction equations for glomerular filtration rate useful for the long-term monitoring of type 2 diabetic patients?

Cited by 69 publications

References 15 publications

New Predictive Equations Improve Monitoring of Kidney Function in Patients With Diabetes

New Predictive Equations Improve Monitoring of Kidney Function in Patients With Diabetes

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Uticaj korekcije anemije bolesnika sa hroničnom bubrežnom insuficijencijom na kardiovaskularni sistem

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