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Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy.
Diabetes Care. 2006 May; 29(5):1024-30.DC

Abstract

OBJECTIVE

The purpose of this study was to assess agreement between glomerular filtration rate (GFR) and the decline in GFR estimated with the Modification of Diet in Renal Disease (MDRD) Study Group equation or the Cockcroft-Gault formula and measured by the plasma clearance of 51Cr-EDTA.

RESEARCH DESIGN AND METHODS

We followed a cohort of 156 microalbuminuric type 2 diabetic patients for 8 years with four measurements of GFR and another cohort of 227 type 2 diabetic patients with overt diabetic nephropathy for 6.5 (range 3-17) years with seven (3-22) measurements of GFR.

RESULTS

For patients with microalbuminuria, mean +/- SD baseline GFR was 117 +/- 24 measured, 92 +/- 20 estimated (MDRD equation), or 103 +/- 24 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001); 95% limits of agreement were -66.1 to 20.3 (MDRD equation) and -58.7 to 30.7 (Cockcroft-Gault formula). The rate of decline in GFR was 4.1 +/- 4.2 measured, 2.9 +/- 2.8 estimated (MDRD equation), or 3.4 +/- 3.2 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001). For patients with overt nephropathy, baseline GFR was 84 +/- 30 measured, 73 +/- 24 estimated (MDRD equation), or 81 +/- 28 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001) with 95% limits of agreement -47 to 25 (MDRD equation) and -39 to 33 (Cockcroft-Gault formula). The rate of decline in GFR was 5.2 +/- 4.1 measured, 4.2 +/- 3.8 estimated (MDRD equation), and 4.6 +/- 4.1 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001).

CONCLUSIONS

Particularly in microalbuminuric (hyperfiltering) patients, GFR is significantly underestimated with wide limits of agreement by the MDRD equation as well as by the Cockcroft-Gault formula. The rate of decline in GFR is also significantly underestimated with both equations. This makes GFR estimations based upon these equations unacceptable for monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy.

Authors+Show Affiliations

Steno Diabetes Center, Gentofte, Denmark. pro@steno.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16644632

Citation

Rossing, Peter, et al. "Monitoring Kidney Function in Type 2 Diabetic Patients With Incipient and Overt Diabetic Nephropathy." Diabetes Care, vol. 29, no. 5, 2006, pp. 1024-30.
Rossing P, Rossing K, Gaede P, et al. Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. Diabetes Care. 2006;29(5):1024-30.
Rossing, P., Rossing, K., Gaede, P., Pedersen, O., & Parving, H. H. (2006). Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. Diabetes Care, 29(5), 1024-30.
Rossing P, et al. Monitoring Kidney Function in Type 2 Diabetic Patients With Incipient and Overt Diabetic Nephropathy. Diabetes Care. 2006;29(5):1024-30. PubMed PMID: 16644632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. AU - Rossing,Peter, AU - Rossing,Kasper, AU - Gaede,Peter, AU - Pedersen,Oluf, AU - Parving,Hans-Henrik, PY - 2006/4/29/pubmed PY - 2006/9/26/medline PY - 2006/4/29/entrez SP - 1024 EP - 30 JF - Diabetes care JO - Diabetes Care VL - 29 IS - 5 N2 - OBJECTIVE: The purpose of this study was to assess agreement between glomerular filtration rate (GFR) and the decline in GFR estimated with the Modification of Diet in Renal Disease (MDRD) Study Group equation or the Cockcroft-Gault formula and measured by the plasma clearance of 51Cr-EDTA. RESEARCH DESIGN AND METHODS: We followed a cohort of 156 microalbuminuric type 2 diabetic patients for 8 years with four measurements of GFR and another cohort of 227 type 2 diabetic patients with overt diabetic nephropathy for 6.5 (range 3-17) years with seven (3-22) measurements of GFR. RESULTS: For patients with microalbuminuria, mean +/- SD baseline GFR was 117 +/- 24 measured, 92 +/- 20 estimated (MDRD equation), or 103 +/- 24 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001); 95% limits of agreement were -66.1 to 20.3 (MDRD equation) and -58.7 to 30.7 (Cockcroft-Gault formula). The rate of decline in GFR was 4.1 +/- 4.2 measured, 2.9 +/- 2.8 estimated (MDRD equation), or 3.4 +/- 3.2 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001). For patients with overt nephropathy, baseline GFR was 84 +/- 30 measured, 73 +/- 24 estimated (MDRD equation), or 81 +/- 28 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001) with 95% limits of agreement -47 to 25 (MDRD equation) and -39 to 33 (Cockcroft-Gault formula). The rate of decline in GFR was 5.2 +/- 4.1 measured, 4.2 +/- 3.8 estimated (MDRD equation), and 4.6 +/- 4.1 ml x min(-1) per 1.73 m2 estimated (Cockcroft-Gault formula) (both P < 0.001). CONCLUSIONS: Particularly in microalbuminuric (hyperfiltering) patients, GFR is significantly underestimated with wide limits of agreement by the MDRD equation as well as by the Cockcroft-Gault formula. The rate of decline in GFR is also significantly underestimated with both equations. This makes GFR estimations based upon these equations unacceptable for monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/16644632/Monitoring_kidney_function_in_type_2_diabetic_patients_with_incipient_and_overt_diabetic_nephropathy_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=16644632 DB - PRIME DP - Unbound Medicine ER -