Hematocrit, Independent of Chronic Kidney Disease, Predicts Adverse Cardiovascular Outcomes in Chinese Patients With Type 2 Diabetes

Tong, Peter C.Y.; Kong, Alice P.S.; So, Wing‐Yee; Ng, Margaret H.L.; Yang, Xilin; Ng, Maggie; Ma, Rong; Ho, Chung-Shun; Lam, Christopher Wai‐Kei; Chow, Chun‐Chung; Cockram, Clive S.; Chan, Juliana C.N.

doi:10.2337/dc06-0887

Cited by 64 publications

(68 citation statements)

References 34 publications

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“…The effects of hyperglycemia (6) and BMI-related bias (5) have led most investigators to avoid using the Cockcroft-Gault equation in recent reports (27,28). As the Cockcroft-Gault equation calculates GFR proportional to body weight, it considerably overestimates obese subjects.…”

Section: Prediction Of Ckd Progressionmentioning

confidence: 99%

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 Progressionmentioning

confidence: 99%

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

et al. 2007

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“…Increasing evidence shows that low hemoglobin level contributes to the progression of left‐ventricular hypertrophy, heart failure, all‐cause and cardiovascular mortality6, 7. Similar effects of anemia on the development of nephropathy were also shown8, 9.…”

Section: Introductionmentioning

confidence: 73%

Lack of association between anemia and renal disease progression in Chinese patients with type 2 diabetes

Lou

Wu³

et al. 2015

J of Diabetes Invest

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Aims/IntroductionAnemia has a close interaction with renal dysfunction in diabetes patients. More proof is still awaited on the relationship between anemia and the progression of renal disease in this population.Materials and MethodsIn the present longitudinal study, 1,645 Chinese type 2 diabetes patients without end‐stage renal disease were included in the analysis in Nanjing, China, during January 2006 and December 2012. All patients were managed by staged diabetes management protocol, and clinical parameters were collected at each visit. The end‐point of progression of renal disease was evaluated during the follow up. Cox regression analysis was used to estimate the risk of anemia on renal disease progression.ResultsOn recruitment, 350 (21.3%) patients had anemia, which was more common among those with older ages, longer diabetes duration, lower estimated glomerular filtration rate or more albuminura. On median follow up of 49 months (range 28–62 months), 37 patients (2.2%) developed the defined renal end‐point. Compared with those without anemia, patients with anemia had a higher risk of renal disease progression. However, multivariate analysis showed that anemia lost its statistical significance once estimated glomerular filtration rate was added into the model. Although the incidence of renal disease progression markedly increased by anemia status in patients of estimated glomerular filtration rate <60 mL/min/1.73 m2, anemia was still not an independent risk factor for renal disease progression in this subgroup.ConclusionsAnemia was a common finding in Chinese type 2 diabetes patients. Anemia was a risk factor for renal disease progression, but lost its significance once baseline renal function was adjusted.

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“…Although it is not ideal the MDRD formula should be calculated in MS individuals. The influences of hyperglicemia (16) and weight raleted bias have led most analyzer to desist from the CG Formula in recent studies (17,18). As the CG Formula estimates GFR relative to weight, it significantly axaggerate overweight subjects.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

Comparison of Modification of Diet in the Renal Disease (MDRD) and Cockroft-Gault (CG) Formulas for Estimating Glomerular Filtration Rate (GFR) in Patients Metabolic Syndrome

Cat¹,

Öztürk²,

Karadağ³

2015

Turk Neph Dial Transpl

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rESultS: Many patients were MS 627 (63%); non MS 372 (37%). In comparison MDRD and CG ; the proportion, according GFR < 60 ml/min/1.73 m2, in MS was high (p=0.015). In MS concerning of GFR were significant (p<0.001), in non MS was not different (p=0.027). In MS we observe a negative correlation between MDRD and uric acid (p<0.001), with CG it was not (p=0.555), between MDRD and albuminuria was not observed a correlation (p=0.263), with between CG and albuminuria there was an incorrect positive relationship. COnCluSIOn:In patients with MS, we recommend using the MDRD equation to predict Evaluation of glomerular filtration rate from serum creatinine concentration, because it is the most accurate in population MS and easily applicable in clinical practice. GErEÇ ve YÖntEMlEr:Hipertansiyon polikliniğinde takip edilen 999 hastanın dosyası geriye dönük olarak incelendi. 627 hasta MS ölçütlerine sahipti. MS tanımı Uluslarası Diyabet Federesyonu kriterlerine göre yapıldı. Böbrek fonksiyonlarının tahmini, kreatinin, yaş, cinsiyet ve kiloya göre, iki formüle göre hesaplandı. Değerlendirilme SPSS 15,0 kullanılarak yapıldı. Anlamlılık düzeyi P < 0, 05 olarak tespit edildi.BulGulAr: Hastaların çoğu, 627 (%63) MS kriterlerini taşıyordu, MS olmayanlar 372 (%37) idi. MDRD ve CG karşılaştırıldığında; hasta oranları, GFH hızı < 60 ml/min/1,73 m2 ye bağlı olarak hesaplandığında MS grupta anlamlı farklılık bulundu (p<0,015). MS grupta GFH hesaplanması anlamlı farklı idi (p<0,001), MS olmayanlarda ise anlamlı değildi (P=0,027). MS grupta ürik asitle MDRD formülü arasında negatif bağlantı gözlemlendi (p<0,001), CG ile bağlantı yoktu(p=0,555). Albuminüri ile MDRD formülü arasında bağlantı yoktu (p=0,263), CG ile bağlantı yanlıştı.

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Hematocrit, Independent of Chronic Kidney Disease, Predicts Adverse Cardiovascular Outcomes in Chinese Patients With Type 2 Diabetes

Cited by 64 publications

References 34 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

Lack of association between anemia and renal disease progression in Chinese patients with type 2 diabetes

Comparison of Modification of Diet in the Renal Disease (MDRD) and Cockroft-Gault (CG) Formulas for Estimating Glomerular Filtration Rate (GFR) in Patients Metabolic Syndrome

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