[Prevalence of "hidden" renal failure in the population suffering from type-2 diabetes]

Diferencias entre MDRD-4 y CG en la prevalencia de la insuficiencia renal y sus variables asociadas en pacientes diabéticos tipo 2

Objetivo

Estimar la prevalencia de insuficiencia renal (IR) oculta en DM2, comparando 2 fórmulas de estimación de filtrado glomerular (EFG): Modification of Diet in Renal Disease 4 (MDRD-4) y Crockcoft-Gault (CG) y las variables clínicas asociadas.

Diseño Analítico transversal multicéntrico.

Emplazamiento

Dos áreas básicas de atención primaria a Terres de l’Ebre.

Participantes

Un total de 493 DM2 con médico asignado en las áreas incluidas y edad > 18 años. Pérdidas de 9 y 11 casos en cada fórmula debido a falta de variables necesarias para EFG.

Mediciones principales

Estimación del filtrado glomerular mediante las 2 fórmulas, valores de creatinina plasmática, clasificación de pacientes con IR establecida, IR oculta y sin IR, posibles variables clinicopatológicas asociadas a la IR.

Resultados

Un 45,2% fueron hombres, con una media de edad 70,4 años y un tiempo de evolución de diabetes de 7,5 años. La prevalencia de IR oculta con MDRD-4 fue del 18%, y del 22,6% con CG. Los casos detectados por CG y no por MDRD-4 fueron mayores y con peso menor. En ambas fórmulas, los pacientes con IR oculta presentaron más patologías crónicas, hipertensión y eventos cardiovasculares (CV) que los sin IR. Los factores de riesgo asociados a IR oculta fueron el ser mujer y el incremento de la edad y del colesterol LDL.

Conclusiones

La prevalencia de IR oculta fue del 20% en DM2 e, independientemente de la fórmula, se observó un peor control de factores CV, lo que les hace ser un grupo de mayor riesgo de sufrir un evento.

Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study

BACKGROUND

The objective of this study was to determinate the prevalence of chronic kidney disease (CKD) and the different stages of CKD in patients with type 2 diabetes mellitus (DM2) treated in primary care consults in Spain.

METHODS

A national cross-sectional study was performed in primary care consults. The following data were collected: demographic and anthropometric information; list of present cardiovascular risk factors (CVRF); previous macrovascular and microvascular disease history; physical examination and analytical data from the previous 12 months, including the urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) to evaluate renal function.

RESULTS

With regard to the patients, 27.9% presented some degree of CKD as follows: 3.5% with stage 1; 6.4% with stage 2; 16.8% with stage 3 (11.6% with stage 3A and 5.2% with stage 3B); and 1.2% with stages 4 and 5. The prevalence of patients with UACR ≥ 30 mg/g was 15.4% (13% microalbuminuria and 2.4% macroalbuminuria). Renal impairment (RI) was found in 206 patients (18%) of whom 133 patients (64.6%) was stage 3A, 60 patients (29.1%) was stage 3B and 13 patients (6.3%) stages 4 and 5. Among patients with RI, 143 patients (69.4%) had normoalbuminuria. The following variables were significantly associated with CKD: age; sex (women); systolic arterial blood pressure (SABP) ≥ 150 mmHg; and a previous history of cardiovascular disease.

CONCLUSIONS

The results showed that the prevalence for any type of CKD was 27.9%. A systematic determination of UACR and eGFR may contribute to an early diagnosis, thus allowing intervention during the initial stages of the disease when treatment is more efficient.

Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area

Background

Kidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM).

Methods

Cross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate & 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate & 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m² and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m², 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m² without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy.

Results

The prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20; CI 95% 1.86–2.59), microvascular disease (OR 2.14; CI 95% 1.8–2.54) and insulin treatment (OR 1.82; CI 95% 1.39–2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80–0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21–0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91–0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09–1.3).

Conclusions

One-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD.

[Prevalence of chronic renal insufficiency in diabetic type 2 diabetes patients based on the estimated glomerular filtration rate and relation with cardiovascular risk]

BACKGROUND AND OBJECTIVE

The aim of this study was: to estimate the prevalence of chronic renal insufficiency (CRI) in diabetic type 2 (DM2) patients treated in Primary Care based on the estimated glomerular filtration rate (GFe); to determine associated factors with CRI, and to evaluate the relationship of GF rate and risk of cardiovascular disease.

PATIENTS AND METHODS

This was a descriptive cross-sectional study. We included 500 medical histories randomly selected in a total of 2,950 DM2 patients. We registered sociodemographic data, comorbidities, cardiovascular risk factors and laboratory data. CRI definition was based on GFe rate and classified according to the K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease.

RESULTS

The prevalence of CRI was 23.2%. There were 51.6% females and the mean age was 66.2 years; 70,4% had hypertension and 67% dyslipidemia. The presence of CRI was related with older age, females, smoking habit, plasma creatinine value, microalbuminuria, and history of hypertension, dyslipidemia and cardiovascular disease. After analysing the data according to the category of GF rate, only the significant relationship with smoking habit disappeared. Multivariate statistic analysis supports a relation with older age, female gender, dyslipidemia and heart disease.

CONCLUSIONS

We confirm a high prevalence of CRI in DM2 patients and their relationship with the presence of cardiovascular disease.

[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]

BACKGROUND AND OBJECTIVE

To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2).

PATIENTS AND METHOD

Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation.

RESULTS

The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia.

CONCLUSIONS

The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring]

OBJECTIVES

To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population.

DESIGN

Descriptive study of validation of diagnostic tests.

SETTING

Urban primary care centre.

PARTICIPANTS

A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session.

MAIN MEASUREMENTS

Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests.

RESULTS

Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage.

CONCLUSIONS

There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal.