Estimation of Glomerular Filtration Rate in Diabetic Subjects

Rigalleau, Vincent; Lasseur, Catherine; Perlemoine, Caroline; Barthe, Nicole; Raffaitin, C.; Liu, Chung; Chauveau, P.; Baillet-Blanco, Laurence; Beauvieux, Marie-Christine; Combe, Christian; Gin, H.

doi:10.2337/diacare.28.4.838

Cited by 171 publications

(120 citation statements)

References 37 publications

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“…When comparing both equations, the GFR values that were obtained with the C-G method were higher, and the differences were larger with higher BMI values. Other studies have shown that, in the presence of obesity/ overweight, the C-G method overestimates GFR and consider the MDRD equation, especially in cases of reduced GFR, to be more accurate (18,19).In the Spanish population pilot study, the prevalence of GFR Ͻ60 ml/m per 1.73 m 2 was 5.1% (20), similar to that (5% of the population) performed in Ͼ500,000 patients in a Canadian population (21). However, when patients with hypertension are studied, there is a greater prevalence of RI.…”

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confidence: 99%

Prevalence of Renal Insufficiency in Individuals with Hypertension and Obesity/Overweight

Gómez

Ruilope²,

Barrios³

et al. 2006

Journal of the American Society of Nephrology

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Overweight and obesity are associated with increased cardiovascular risk. Some studies have demonstrated that they also can result in renal damage. The aim of this study was to assess the prevalence of renal insufficiency (RI), defined as a GFR <60 ml/min per 1.73 m 2 , in a cohort of 4585 patients who attended primary care with essential hypertension and a body mass index >25 kg/m 2 . The patients were classified as overweight and obese according to body mass index (25 to 29.9 and >30 kg/m 2 , respectively). Abdominal obesity was defined as a waist circumference >88 and 102 cm in women and men, respectively. Both groups had a high prevalence of metabolic syndrome (Adult Treatment Panel III). The prevalence of RI was high in both the overweight group (22.7%; 95% confidence interval [CI] 20.6 to 24.9) and in the obese group (22.8%; 95% CI 21.0 to 24.7). The presence of diabetes increased the risk for RI (odds ratio 1.83; 95% CI 1.55 to 2.16). The prevalence of RI was greater in patients with abdominal obesity (23 versus 17%; P < 0.001). In the presence of abdominal obesity, cardiovascular risk factors and components of the metabolic syndrome also were more prevalent. The higher risk for RI with abdominal obesity persisted even after adjustment for dyslipidemia, elevated blood glucose levels, and other variables that are associated with RI (adjusted odds ratio 1.40; 95% CI 0.84 to 2.33). It was concluded that patients who have hypertension and visceral obesity and attend primary care present a higher prevalence of metabolic syndrome and RI.J Am Soc Nephrol 17: S194 -S200, 2006. doi: 10.1681/ASN.2006080914 C hronic kidney disease (CKD) is a widely known cardiovascular risk factor. Renal insufficiency (RI) and micro-or macroalbuminuria, both manifestations of CKD, are associated with increased cardiovascular morbidity and mortality (1-4).The application of equations to estimate GFR has revealed an important and growing prevalence of CKD, associated with vascular events both in population-based studies and in patients with cardiovascular risk factors (5,6). Some epidemiologic studies have demonstrated an association between obesity and CKD. A high body mass index (BMI) increases the risk for a reduced GFR in both men and women (7). Obesity can be associated with glomerulosclerosis and also can facilitate a loss of renal function in patients with other kidney diseases (8,9). The risk for presenting RI as defined by a GFR Ͻ60 ml/min per 1.73 m 2 and end-stage renal failure as defined by the need for kidney transplant or dialysis increases with the rise in BMI (10,11).It therefore is likely that increased prevalence of CKD could be due, at least partially, to an increase in comorbidities such as overweight and obesity and the combination of associated hemodynamic and metabolic disorders that result in metabolic syndrome (MS). Awareness of the association between overweight/obesity and RI is important to adopt preventive and therapeutic measures for this risk factor of CKD. The present study assessed the prevalence of on...

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Prevalence of Renal Insufficiency in Individuals with Hypertension and Obesity/Overweight

Gómez

Ruilope²,

Barrios³

et al. 2006

Journal of the American Society of Nephrology

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“…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.…”

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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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“…Using the NHANES III data, a GFR Ͻ60 ml/min is estimated to be present in 26% of patients who are Ն70 yr of age (14). Finally, diabetes currently affects 194 million people worldwide, and the number of affected individuals in future years is expected to be significantly greater (10,15). It is estimated that diabetic nephropathy affects 25 to 40% of patients with this disease (16).…”

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Contrast-Induced Nephropathy

Rudnick

Goldfarb

Tumlin

2008

Clinical Journal of the American Society of Nephrology

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A lthough the clinical features of contrast-induced nephropathy (CIN) have been well described for some time (1,2), during the past 15 yr, interest among physicians on the subject of CIN has dramatically increased. A PubMed search of the phrase "contrast-induced nephropathy" between 1990 and 2007 produced 347 citations. During the past 5 yr alone, there were 290 citations, 159 of which appeared since 2006 (3).Intravascular administration of contrast is widely known to be a common cause of hospital-acquired acute kidney injury (AKI). In 1983, Hou et al. (4) prospectively evaluated 2216 patients with hospital-acquired AKI and found decreased renal perfusion and major surgery to be the leading causes of AKI. Contrast medium (CM) was the next most common cause, accounting for 12% of cases of AKI, and was associated with an in-hospital mortality of 6%. In 1987, Shusterman et al. (5) demonstrated that CM was one of four major factors contributing to hospital acquired AKI (the others being volume depletion, congestive heart failure, and aminoglycosides).The exact risk for CIN is difficult to determine. It is widely known that in patients with normal renal function, even in the presence of diabetes, the risk for CIN is Յ1 to 2% (1). In patients with chronic kidney disease (CKD), it is also well accepted that the risk for CIN is significantly increased and rises in proportion to the severity of underlying renal impairment (1,6,7). Another established observation is that the coupling of CKD and diabetes dramatically increases the risk for CIN compared with that observed for CKD alone (6). Recent studies on CIN in "high-risk" patients have demonstrated a wide range of incidences from 1 to 45% (8,9). Reasons for this wide variation in CIN risk include study differences in the number and severity of underlying risk factors, definition of CIN used, prospective or retrospective collection of data, exclusion or nonexclusion of patients with other AKI etiologies, timing of the baseline serum creatinine (SCr) relative to hydration administration, type and amount of CM used, type and amount of hydration, and presence or absence of other prophylactic measures. Unfortunately, the consequence of these multiple factors makes it difficult to state with reasonable accuracy the clinical risk for CIN in a "high-risk" patient. Additional problems caused by the apparently observed wide range of CIN incidences are methodologically inadequate comparisons of studies for the value of procedural or prophylactic strategies to minimize CIN risk and prospective, randomized, controlled trials that are underpowered to answer the question for which they were designed.Despite the uncertainty of the incidence of CIN in "high-risk" patients, there are a number of reasons to believe that CIN will be an increasing cause of hospital-and outpatient-acquired AKI. Use of intravascular contrast is widespread and continues to expand. In 2003, 80 million doses of CM were administered worldwide (10,11). As of 2004, 3.3 million coronary angiograms, 25.7 million c...

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Estimation of Glomerular Filtration Rate in Diabetic Subjects

Cited by 171 publications

References 37 publications

Prevalence of Renal Insufficiency in Individuals with Hypertension and Obesity/Overweight

Prevalence of Renal Insufficiency in Individuals with Hypertension and Obesity/Overweight

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

Contrast-Induced Nephropathy

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