The use of eGFR and ACR to predict decline in renal function in people with diabetes

Hoefield, Richard; Kalra, Philip A.; Baker, Peter; Sousa, Inês; Diggle, Peter J.; Gibson, John M.; O’Donoghue, Dónal; Middleton, Rachel; New, John P.

doi:10.1093/ndt/gfq526

Cited by 63 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data were analyzed using longitudinal mixed effect dynamic regression models and variables were set according to the maximum likelihood. Results showed that in diabetic patients, eGFR declined at a rate of 5.7%, 1.5% and 0.3% per year in those with macroalbuminuria, microalbuminuria and without albuminuria, respectively, regardless of age (P< 0.0001) [56]. Thus, this adds further evidence that there is a pivotal prognostic value of albuminuria in DN progression.…”

Section: Urinary Markersmentioning

confidence: 54%

“…Furthermore, a population-based cohort study analyzed data collected on 3431 individuals with DM in Salford, UK with the aim of identifying the rate of progression of CKD in DM patients in relation to their eGFR (calculated utilizing four-variable modified diet in renal disease (MDRD) formula) and existence of albuminuria (using urinary albumin-creatinine ratio (UACR) data) [56]. Data were analyzed using longitudinal mixed effect dynamic regression models and variables were set according to the maximum likelihood.…”

Section: Urinary Markersmentioning

confidence: 99%

“…Thus, this adds further evidence that there is a pivotal prognostic value of albuminuria in DN progression. However, the study was limited by using creatinine-based estimation (MDRD) formula that is known to underestimate GFR decline in DM [56,57].…”

Section: Urinary Markersmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

View full text Add to dashboard Cite

AbstractDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Alarming recent data described diabetes as an unprecedented worldwide epidemic, with a prevalence of ∼6.4% of the world population in 2010, while the prevalence of CKD among diabetics was approximately 40%. With a clinical field hungry for novel markers predicting DN, several clinical and laboratory markers were identified lately with the promise of reliable DN prediction. Among those are age, gender, hypertension, smoking, sex hormones and anemia. In addition, eccentric left ventricular geometric patterns, detected by echocardiography, and renal hypertrophy, revealed by ultrasonography, are promising new markers predicting DN development. Serum and urinary markers are still invaluable elements, including serum uric acid, microalbuminuria, macroalbuminuria, urinary liver-type fatty acid-binding protein (u-LFABP), and urinary nephrin. Moreover, studies have illustrated a tight relationship between obstructive sleep apnea and the development of DN. The purpose of this review is to present the latest advances in identifying promising predictors to DN, which will help guide the future research questions in this field. Aiming at limiting this paramount threat, further efforts are necessary to identify and control independent modifiable risk factors, while developing an integrative algorithm for utilization in DN future screening programs.

show abstract

Section: Urinary Markersmentioning

confidence: 54%

Section: Urinary Markersmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

View full text Add to dashboard Cite

show abstract

“…Indeed, according to this study, GPs can be considered as a reference of care for patients in stage 3a without asking for nephrology consultation, because these patients have the same risk as the reference group (Table 4). The clinical characteristics of our patients with CKD stage 3a, in fact, show low prevalence for the main cardiorenal risk factors (i.e., albuminuria, anemia, diabetes, and CAD) with respect to more advanced stages of CKD (3b-5), and therefore, their profile is compatible with nonprogressive CKD (26)(27)(28)(29)(30). However, the suggestion of referring patients with CKD when eGFR is ,45 ml/min per 1.73m 2 is in agreement with the timing of onset of CKD-related metabolic complications (31).…”

Section: Discussionmentioning

confidence: 79%

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Minutolo

Lapi

Chiodini

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Rising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Results Overall 64% of patients were in stage 3a, and 4.5% of patients were in stages 3b-5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a-5. Hypertension was frequent in all CKD stages (80%-94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7-7.7), 6592 patients died and 295 started ESRD. Compared with stages 1 and 2 (reference), mortality risk (hazard ratio, 95% confidence interval) was higher in stages 3b-5 (1.66, 1.49-1.86, 2.75, 2.41-3.13 and 2.54, 2.01-3.22, respectively) but not stage 3a (1.11, 0.99-1.23). Similarly, ESRD risk (hazard ratio, 95% confidence interval) was not higher at stage 3a (1.44, 0.79-2.64) but was greater in stages 3b-5 (11.0, 6.3-19.5, 91.2, 53.2-156.2 and, 122.8, 67.9-222.0, respectively). Among modifiable risk factors, anemia and albuminuria significantly predicted either outcome, whereas hypertension only predicted mortality.Conclusions In patients with CKD not referred to nephrology, risks of ESRD and mortality were higher in those with CKD stages 3b-5.

show abstract

“…Interestingly, although enrollment of eligible patients, randomization, and blinding were conducted properly, the eGFR in the placebo group declined 6% within half a year. It was reported that the rate of eGFR decline in diabetic patients with microalbuminuria is about 1.0-2.0% per year [19,20]. Hence eGFR of patients in this study seemed to decline rapidly.…”

Section: Discussionmentioning

confidence: 46%

Uric acid-lowering and renoprotective effects of topiroxostat, a selective xanthine oxidoreductase inhibitor, in patients with diabetic nephropathy and hyperuricemia: a randomized, double-blind, placebo-controlled, parallel-group study (UPWARD study)

et al. 2018

View full text Add to dashboard Cite

Background Hyperuricemia is supposed to be an independent risk factor for kidney dysfunction in diabetic patients. We attempted to examine the uric acid-lowering effect and the renoprotective effect of topiroxostat, a selective xanthine oxidoreductase inhibitor, in patients with diabetic nephropathy and hyperuricemia in this pilot study. Methods The study design was randomized, double-blind, placebo-controlled, parallel-group study. A total of 65 patients with hyperuricemia and diabetic nephropathy with microalbuminuria were enrolled and assigned to either the topiroxostat group or the placebo group. Topiroxostat (stepwise dosing from 40 to 160 mg/day) or matching placebo was administered BID for 28 weeks. The primary endpoint was a change in the urinary albumin-to-creatinine ratio in the first-morning-void urine sample. Secondary endpoints were changes in the estimated glomerular filtration rate and the serum uric acid level. Results At 28 weeks, there was no significant difference in the percent change from baseline in the urinary albumin-tocreatinine ratio between the two groups (topiroxostat: 0 vs. placebo: 17%, p = 0.3206), but the changes in the estimated glomerular filtration rate (− 0.2 vs. − 4.0 mL/min/1.73 m 2 , p = 0.0303) and the serum uric acid level (− 2.94 vs. − 0.20 mg/ dL, p < 0.0001) were significantly different between the topiroxostat and placebo groups. Gouty arthritis occurred in 1 patient in the placebo group and no patients in the topiroxostat group. Conclusion These findings support that diabetic nephropathy combined with hyperuricemia may be associated with kidney dysfunctions. Topiroxostat provides strict control of the serum uric acid level preventing decline of eGFR in these patients.

show abstract

The use of eGFR and ACR to predict decline in renal function in people with diabetes

Cited by 63 publications

References 29 publications

Predictors of diabetic nephropathy

Predictors of diabetic nephropathy

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Uric acid-lowering and renoprotective effects of topiroxostat, a selective xanthine oxidoreductase inhibitor, in patients with diabetic nephropathy and hyperuricemia: a randomized, double-blind, placebo-controlled, parallel-group study (UPWARD study)

Contact Info

Product

Resources

About