1. The Error of Estimated GFR in Type 2 Diabetes Mellitus
- Author
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Macarena Sánchez-Gallego, Santiago Domínguez-Coello, Ana González-Rinne, Alejandro Jiménez-Sosa, Ana-María Armas-Padrón, Laura Díaz-Martín, Candelaria Martín, Asunción María López-Hijazo, Tomás Higueras Linares, Marina López-Martínez, Angeles Jimenez, Sara Estupiñán, Esteban Porrini, Rafael Valcárcel-Lopez, Maria Angeles Cobo-Caso, Laura Henríquez-Gómez, Patricia Delgado-Mallén, Federico González-Rinne, Rosa María Miquel Rodríguez, Raquel Alonso-Pescoso, Manuel Castilla-Marrero, Vanesa Vilchez de León, Natalia Negrín-Mena, Sara Judith Galindo-Hernández, Beatriz Escamilla, Raquel Socas Fernández del Castillo, Domingo Marrero-Miranda, Nerea Insausti-Garmendia, Alejandra González-Delgado, Sergio Luis-Lima, and Armando Torres
- Subjects
medicine.medical_specialty ,measured glomerular filtration rate ,endocrine system diseases ,Type II diabetes mellitus ,estimated glomerular filtration rate ,Population ,Urology ,lcsh:Medicine ,Renal function ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Article ,End stage renal disease ,plasma clearance of iohexol ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,renal disease ,Diabetes mellitus ,Medicine ,030212 general & internal medicine ,education ,education.field_of_study ,Creatinine ,business.industry ,lcsh:R ,nutritional and metabolic diseases ,Type 2 Diabetes Mellitus ,General Medicine ,Gold standard (test) ,medicine.disease ,chemistry ,business ,Kidney disease - Abstract
Type 2 diabetes mellitus represents 30&ndash, 50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtration rate in diabetic patients. We evaluated the error of creatinine and/or cystatin-C based formulas in reflecting real renal function over a wide range of glomerular filtration rate (from advanced chronic kidney disease to hyperfiltration). The error of estimated glomerular filtration rate by any equation was common and wide averaging 30% of real renal function, and larger in patients with measured glomerular filtration rate below 60 mL/min. This led to chronic kidney disease stages misclassification in about 30% of the individuals and failed to detect 25% of the cases with hyperfiltration. Cystatin-C based formulas did not outperform creatinine based equations, and the reliability of more modern algorithms proved to be as poor as older equations. Formulas failed in reflecting renal function in type 2 diabetes mellitus. Caution is needed with the use of these formulas in patients with diabetes, a population at high risk for kidney disease. Whenever possible, the use of a gold standard method to measure renal function is recommended.
- Published
- 2019