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Glucose control influences glomerular filtration rate and its prediction in diabetic subjects.
Diabetes Care. 2006 Jul; 29(7):1491-5.DC

Abstract

OBJECTIVE

Hyperglycemia increases glomerular filtration rate (GFR), but the influence of HbA(1c) (A1C) on GFR and GFR's prediction by recommended equations remains to be determined.

RESEARCH DESIGN AND METHODS

In 193 diabetic patients, we searched for an association between A1C and isotopically measured GFR (51Cr-EDTA) and their predictions by the Cockcroft and Gault formula (CG) and the modification of diet in renal disease (MDRD) equation. Their accuracy for the diagnosis of moderate (GFR <60 ml/min per 1.73 m(2)) or severe (GFR <30 ml/min per 1.73 m(2)) renal failure was compared from receiver operating characteristic (ROC) curves, before and after categorizing the patients as well (A1C <or=8%) or poorly controlled.

RESULTS

The mean GFR was 57.0 +/- 34.8 ml/min per 1.73 m(2) and was well correlated with both estimations (CG r = 0.75, MDRD r = 0.83; P < 0.05). The areas under the ROC curves were higher with the MDRD (P < 0.05). A1C was correlated (P < 0.001) with the GFR (r = 0.29), MDRD (r = 0.38), CG (r = 0.26), and the absolute differences between the GFR and their CG but not MDRD estimations (r = 0.17, P < 0.05). Each +1% A1C was associated with +6.0 ml/min per 1.73 m(2) GFR (CG +5.6, MDRD +5.3). After separating well-controlled (n = 88, A1C 7.0 +/- 0.7%) and poorly controlled (n = 105, 9.6 +/- 1.3%) patients, the diagnostic accuracies were better (P < 0.05) for the MDRD, except for the diagnosis of moderate renal failure in well-controlled patients (NS).

CONCLUSIONS

GFR and its estimations correlate with A1C. Although the relations between GFR and its estimations were not affected by the degree of glucose control, the precision and diagnostic accuracy of the CG formula were diminished for A1C >8%. The MDRD equation was more accurate and robust in diabetic patients with impaired renal function.

Authors+Show Affiliations

Nutrition-Diabétologie, Hôpital Haut-Lévêque, Avenue de Magellan, 33600 Pessac, France. vincent.rigalleau@wanadoo.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16801567

Citation

Rigalleau, Vincent, et al. "Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects." Diabetes Care, vol. 29, no. 7, 2006, pp. 1491-5.
Rigalleau V, Lasseur C, Raffaitin C, et al. Glucose control influences glomerular filtration rate and its prediction in diabetic subjects. Diabetes Care. 2006;29(7):1491-5.
Rigalleau, V., Lasseur, C., Raffaitin, C., Perlemoine, C., Barthe, N., Chauveau, P., Combe, C., & Gin, H. (2006). Glucose control influences glomerular filtration rate and its prediction in diabetic subjects. Diabetes Care, 29(7), 1491-5.
Rigalleau V, et al. Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects. Diabetes Care. 2006;29(7):1491-5. PubMed PMID: 16801567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucose control influences glomerular filtration rate and its prediction in diabetic subjects. AU - Rigalleau,Vincent, AU - Lasseur,Catherine, AU - Raffaitin,Christelle, AU - Perlemoine,Caroline, AU - Barthe,Nicole, AU - Chauveau,Philippe, AU - Combe,Christian, AU - Gin,Henri, PY - 2006/6/28/pubmed PY - 2006/11/2/medline PY - 2006/6/28/entrez SP - 1491 EP - 5 JF - Diabetes care JO - Diabetes Care VL - 29 IS - 7 N2 - OBJECTIVE: Hyperglycemia increases glomerular filtration rate (GFR), but the influence of HbA(1c) (A1C) on GFR and GFR's prediction by recommended equations remains to be determined. RESEARCH DESIGN AND METHODS: In 193 diabetic patients, we searched for an association between A1C and isotopically measured GFR (51Cr-EDTA) and their predictions by the Cockcroft and Gault formula (CG) and the modification of diet in renal disease (MDRD) equation. Their accuracy for the diagnosis of moderate (GFR <60 ml/min per 1.73 m(2)) or severe (GFR <30 ml/min per 1.73 m(2)) renal failure was compared from receiver operating characteristic (ROC) curves, before and after categorizing the patients as well (A1C <or=8%) or poorly controlled. RESULTS: The mean GFR was 57.0 +/- 34.8 ml/min per 1.73 m(2) and was well correlated with both estimations (CG r = 0.75, MDRD r = 0.83; P < 0.05). The areas under the ROC curves were higher with the MDRD (P < 0.05). A1C was correlated (P < 0.001) with the GFR (r = 0.29), MDRD (r = 0.38), CG (r = 0.26), and the absolute differences between the GFR and their CG but not MDRD estimations (r = 0.17, P < 0.05). Each +1% A1C was associated with +6.0 ml/min per 1.73 m(2) GFR (CG +5.6, MDRD +5.3). After separating well-controlled (n = 88, A1C 7.0 +/- 0.7%) and poorly controlled (n = 105, 9.6 +/- 1.3%) patients, the diagnostic accuracies were better (P < 0.05) for the MDRD, except for the diagnosis of moderate renal failure in well-controlled patients (NS). CONCLUSIONS: GFR and its estimations correlate with A1C. Although the relations between GFR and its estimations were not affected by the degree of glucose control, the precision and diagnostic accuracy of the CG formula were diminished for A1C >8%. The MDRD equation was more accurate and robust in diabetic patients with impaired renal function. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/16801567/Glucose_control_influences_glomerular_filtration_rate_and_its_prediction_in_diabetic_subjects_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=16801567 DB - PRIME DP - Unbound Medicine ER -