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Wang D, Hu X, Jin H, Liu J, Chen X, Qin Y, Zhang Y, Xiang Q. Impaired kidney function and the risk of all-cause mortality and cardiovascular disease among Chinese hypertensive adults: Using three different equations to estimate the glomerular filtration rate. Prev Med 2024; 180:107869. [PMID: 38266581 DOI: 10.1016/j.ypmed.2024.107869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES We aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations. METHODS In this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models. RESULTS The Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60-89 mL/min/1.73m2 or < 60 mL/min/1.73m2) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05-1.55] and 1.89 [95% CI, 1.08-3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09-1.50] and 1.68 [95% CI, 1.01-2.78]). CONCLUSIONS The MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality.
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Affiliation(s)
- Dan Wang
- School of Public Health, Southeast University, Nanjing, China; Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangju Hu
- Department of Chronic Non-communicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Hang Jin
- School of Public Health, Southeast University, Nanjing, China
| | - Jiali Liu
- School of Public Health, Southeast University, Nanjing, China
| | - Xin Chen
- School of Public Health, Southeast University, Nanjing, China
| | - Yu Qin
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yongqing Zhang
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Quanyong Xiang
- School of Public Health, Southeast University, Nanjing, China; Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
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Cosentino N, Trombara F, Marenzi G. Glomerular filtration rate estimation and all-cause and cardiovascular mortality risk prediction: a progressive refinement in accuracy. Eur J Prev Cardiol 2023; 30:1652-1653. [PMID: 37335946 DOI: 10.1093/eurjpc/zwad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| | - Filippo Trombara
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
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Mendivil CO, Gnecco-González S, Herrera-Parra LJ, Hernández Vargas JA, Ramírez-García N, Acuña-Merchán L. MDRD is the eGFR equation most strongly associated with 4-year mortality among patients with diabetes in Colombia. BMJ Open Diabetes Res Care 2023; 11:e003495. [PMID: 37474261 PMCID: PMC10360417 DOI: 10.1136/bmjdrc-2023-003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION We compared the association of glomerular filtration rate (GFR) estimated with the Cockcroft-Gault, Modification of Diet in Renal Disease study (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), or the new CKD-EPI without race (CKD-EPI-NR) equations, with 4-year all-cause mortality in patients with diabetes. RESEARCH DESIGN AND METHODS We analyzed a nationwide, centralized database of all adults diagnosed with diabetes assisted by the Colombian Health System between July 1, 2015, and June 30, 2019. Plasma creatinine was used to calculate baseline estimated glomerular filtration rate (eGFR) and classify each patient in a chronic kidney disease (CKD) stage, by each of the four equations. We used multivariate logistic regression to compare the association between CKD stage and mortality, and receiver operating characteristic (ROC) analyses to assess the overall association of eGFR by each equation and mortality. RESULTS The study included 758,219 patients (58% female, 7.2% black race, mean age 62.3, Glycated hemoglobin A1c [HbA1c] 7.4%). There were 35,296 deaths over the study follow-up. Considering eGFR by each equation as a continuous variable, the odds of death decreased by 1.1%-1.5% for each additional mL/min. Compared with CKD stage 1 of each equation, being placed in CKD stages 3a, 3b, or 4 by MDRD or CKD-EPI-NR was associated with greater odds of death than being categorized in the same stages by CKD-EPI. Among patients of black race, the adjusted OR of mortality for CKD stage 4 relative to stage 1 was 4.63 (95% CI 3.39 to 6.35) for MDRD, 3.66 (2.85 to 4.69) for CKD-EPI-NR, 3.01 (2.38 to 3.81) for CKD-EPI, and 2.82 (2.29 to 3.49) for Cockcroft-Gault. The area under the ROC curve to discriminate by survival status was greatest for MDRD, followed by CKD-EPI-NR, CKD-EPI, and Cockcroft-Gault, in that order (p<0.001 for all differences). CONCLUSIONS Compared with other eGFR equations, MDRD showed the strongest association with all-cause mortality in a sample of Latin-American patients with diabetes. This difference was most pronounced among patients of black race.
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Affiliation(s)
- Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Bogota, Colombia
- Endocrinology Section, Fundación Santa Fe de Bogotá, Bogota, DC, Colombia
| | | | - Lina J Herrera-Parra
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
| | | | - Nathaly Ramírez-García
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
| | - Lizbeth Acuña-Merchán
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
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Liau YJ, Lin SF, Lee IT. Scores of peripheral neuropathic pain predicting long-term mortality in patients with type 2 diabetes: A retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:969149. [PMID: 36051389 PMCID: PMC9424503 DOI: 10.3389/fendo.2022.969149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Diabetic peripheral neuropathic pain (DPNP) is a prevalent chronic complication in patients with diabetes. Using a questionnaire is helpful for DPNP screening in outpatients. In this retrospective cohort, we aimed to examine whether DPNP diagnosed based on scoring questionnaires could predict long-term mortality in outpatients with type 2 diabetes. METHODS We enrolled 2318 patients who had joined the diabetes pay-for-performance program and completed the annual assessments, including both the identification pain questionnaire (ID pain) and Douleur Neuropathique en 4 questionnaire (DN4), between January 2013 and October 2013. Information on registered deaths was collected up to August 2019. RESULTS There was high consistency in the scores between the ID pain and DN4 (r = 0.935, P < 0.001). During the median follow-up of 6.2 years (interquartile range: 5.9-6.4 years), 312 patients deceased. Patients with an ID pain score of ≥ 2 had a higher mortality risk than those with a score of < 2 (hazard ratio [HR] = 1.394, 95%CI: 1.090-1.782), and patients with a DN4 score of ≥ 4 had a higher mortality risk than those with a score of < 4 (HR = 1.668, 95% confidence interval [CI]: 1.211-2.297). Patients consistently diagnosed with DPNP by the ID pain and DN4 had a significantly higher mortality risk (HR = 1.713, 95% CI: 1.223-2.398, P = 0.002), but not those discrepantly diagnosed with DPNP (P = 0.107), as compared with those without DPNP. CONCLUSIONS Both the ID pain and DN4 for DPNP screening were predictive of long-term mortality in patients with type 2 diabetes. However, a discrepancy in the diagnosis of DPNP weakened the power of mortality prediction.
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Affiliation(s)
- Yi-Ju Liau
- Department of Psychiatry, Jen-Ai Hospital, Taichung, Taiwan
| | - Shu-Fan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: I-Te Lee,
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Chang YS, Li YH, Lee IT. A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study. Cardiovasc Diabetol 2021; 20:209. [PMID: 34663321 PMCID: PMC8524871 DOI: 10.1186/s12933-021-01399-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality. Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM. Methods In this retrospective cohort study, we enrolled patients with eGFR data between 01 Aug 2017 and 31 July 2018. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR < 60 mL/min/1.73 m2) and 2633 patients without CKD. We assessed eGFR variability by using the standard deviation (SD) of the three annual eGFR and index eGFR values. We divided patients into subgroups according to the median SD of their annual eGFR (7.62 mL/min/1.73 m2). The primary endpoint was all-cause mortality after the index eGFR was assessed. Results During a median follow-up of 19 months (interquartile range: 18‒20 months), 127 (3.5%) deaths occurred among all 3592 enrolled patients. The highest mortality risk was observed in the high SD with CKD group, with a hazard ratio (HR) of 2.382 [95% confidence interval (CI) 1.346‒4.215] in comparison to the low SD without CKD group after adjusting for the associated factors. In patients without CKD, a high SD was an independent risk factor for mortality (HR = 2.105, 95% CI 1.256‒3.528). According to the C-index, the mortality prediction ability was better for the index eGFR + SD model than for the index eGFR alone model (0.671 vs. 0.629, P < 0.001). Conclusion There was a synergistic effect of eGFR variability with single-measured eGFR for the prediction of mortality in patients with type 2 DM. The SD of the annual eGFR values was also an independent predictor of mortality in patients with an eGFR > 60 mL/min/1.73 m2. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01399-z.
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Affiliation(s)
- Yu-Shan Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan
| | - Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
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Lingli X, Qing Z, Wenfang X. Diagnostic value of the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations in diabetic patients: a systematic review and meta-analysis. J Int Med Res 2020; 48:300060520925950. [PMID: 32589856 PMCID: PMC7436805 DOI: 10.1177/0300060520925950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations are common for calculating estimated glomerular filtration rate (eGFR). Unlike CKD, the key pathological change of diabetic kidney disease (DKD) is glomerulosclerosis. METHODS To conduct a meta-analysis of the diagnostic performance of the CKD-EPI and MDRD equations in diabetic patients, we searched PubMed, Embase and the Cochrane Library for studies comparing standard GFR (sGFR) with eGFR using these two equations. RESULTS Thirteen studies of 7192 diabetic patients reporting data on bias or accuracy were included. At the study level, both equations underestimated eGFR. CKD-EPI was more accurate in studies with mean GFR ≥60 mL/minute/1.73 m2. At the individual level, both equations overestimated GFR by 6.38 mL/minute/1.73 m2 (95% confidence interval [CI] 2.67-10.1) and 7.65 mL/minute/1.73 m2 (95% CI 2.78-12.52), respectively, for sGFR < 90 mL/minute/1.73 m2. The CKD-EPI equation was 7.61% (95% CI 4.66-10.56) more accurate in subjects with sGFR > 90 mL/minute/1.73 m2. The CKD-EPI equation performed poorly in diabetic patients. CONCLUSIONS The CKD-EPI equation can be used to estimate GFR in patients with incipient DKD, but has drawbacks. Improved eGFR equations suitable for diabetic populations are needed.
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Affiliation(s)
- Xie Lingli
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Zhang Qing
- Department of Endocrinology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Xia Wenfang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
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7
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Mantovani A, Zusi C, Sani E, Colecchia A, Lippi G, Zaza G, Valenti L, Byrne C, Maffeis C, Bonora E, Targher G. Association between PNPLA3rs738409 polymorphism decreased kidney function in postmenopausal type 2 diabetic women with or without non-alcoholic fatty liver disease. DIABETES & METABOLISM 2019; 45:480-487. [DOI: 10.1016/j.diabet.2019.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/12/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
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8
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Tancredi M, Rosengren A, Svensson AM, Pivodic A, Gudbjörnsdottir S, Wedel H, Lind M. Glycaemic control and excess risk of major coronary events in patients with type 2 diabetes: a population-based study. Open Heart 2019; 6:e000967. [PMID: 31565231 PMCID: PMC6744076 DOI: 10.1136/openhrt-2018-000967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/18/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022] Open
Abstract
Objective The purpose of the study was to investigate the excess risk of acute myocardial infarction (AMI) and death from coronary artery disease (coronary heart disease, CHD) in relation to age, level of glycaemic control and renal complications in patients with type 2 diabetes. Methods A total of 431 579 patients with type 2 diabetes mellitus registered in the Swedish National Diabetes Register from 1 January 1998 to 31 December 2012, and 2 173 620 controls from the general population were included. Cox regression was used to study the excess risk of AMI and CHD. Results During follow-up of 5.1 years in the diabetes group and 5.4 years in the control group, 36 124 (8.4%) and 115 712 (5.3%) CHD events were registered, with corresponding incidence rates/1000 person-years of 14.64 (95% CI 14.49 to 14.79) and 8.73 (95% CI 8.68 to 8.78), respectively. The HR after adjustment for sex and age was 1.67 (1.65-1.69) which was reduced to 1.42 (1.41-1.44) with further adjustment for level of education, country of birth, diabetes duration and comorbidities. The multivariable-adjusted HR for AMI and CHD death with a time-updated glycated haemoglobin level of 6.9% or lower (≤52 mmol/mol) together with normoalbuminuria and estimated glomerular filtration rate ≥60 mL/min for patients with diabetes compared with controls was 0.95 (95% CI 0.92 to 0.98, p<0.001). Conclusions In this study, the excess risk of AMI and CHD death was higher for patients with type 2 diabetes compared with controls but converged to that in the general population in patients with on-target HbA1c levels and without renal complications.
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Affiliation(s)
- Mauro Tancredi
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU-Hospital Organization, Trollhättan and Uddevalla, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre of Registers in region Västra Götaland, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hans Wedel
- Health Metrics Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU-Hospital Organization, Trollhättan and Uddevalla, Sweden
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9
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Wang J, Huang J, Li W, Tang S, Sun J, Zhang X, Liu J, Yi B, Liu J, Zhang X, Yang Q, Yang X, Yang S, Yang G, Zhang H. Polyethylene glycol loxenatide (PEX168) in subjects with renal impairment: A pharmacokinetic study. Br J Clin Pharmacol 2019; 85:2714-2720. [PMID: 31396983 PMCID: PMC6955414 DOI: 10.1111/bcp.14091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/13/2019] [Accepted: 07/26/2019] [Indexed: 12/29/2022] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) is commonly complicated by renal impairment. Polyethylene glycol loxenatide (PEX168) is a novel long‐acting glucagon‐like peptide‐1 receptor agonist for T2DM. PEX168 pharmacokinetics was studied to identify requirements for dose‐modification in T2DM complicated by renal impairment. Methods This was a single‐centre, open‐labelled, parallel‐group, single‐dose, phase I clinical trial of patients with mild and moderate renal impairment, and with or without T2DM. Age‐, sex‐ and body mass index‐matched subjects with normal renal function, and with or without T2DM were recruited as controls. Subjects received a single abdominal subcutaneous injection of PEX168 200 μg. Pharmacokinetic samples were taken at 0, 24, 48, 72, 96, 120, 144, 216, 312, 480, 648 and 720 hours. Results Twenty‐three patients were included in the pharmacokinetics analysis. Vz/F and CL/F were lower in the moderate impairment group than in the other groups. The mean t1/2 (163 hours) in the moderate impairment group was prolonged compared to the mild impairment (117 hours) and normal (121 hours) groups. AUC0–inf increased by 13 and 100.7% in patients with mild and moderate renal impairment, respectively. Most adverse events were mild gastrointestinal disorders, with only 1 serious adverse event observed. Conclusion A single dose of 200 μg of PEX168 was in general well tolerated in patients with renal impairment. The in vivo clearance rate of PEX168 in patients with moderate renal impairment is slower than in patients with mild renal impairment and normal renal function and dose adjustment might be required (http://ClinicalTrials.org #NCT02467790).
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Affiliation(s)
- Jianwen Wang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shiqi Tang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Sun
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xianming Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Yi
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jishi Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingfei Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoyan Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuang Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China.,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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10
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Association between decreasing estimated glomerular filtration rate and risk of cardiac conduction defects in patients with type 2 diabetes. DIABETES & METABOLISM 2018; 44:473-481. [PMID: 30195089 DOI: 10.1016/j.diabet.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/04/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
Abstract
AIM We aimed to assess the association between decreasing estimated glomerular filtration rate (eGFR) or abnormal albuminuria and the risk of certain cardiac conduction defects in patients with type 2 diabetes mellitus (T2DM). METHODS We examined a hospital-based sample of 923 patients with T2DM discharged from our Division of Endocrinology over the years 2007-2014. Standard electrocardiograms (ECGs) were performed in all patients. eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, whilst albuminuria was measured by an immuno-nephelometric method on morning spot urine samples. RESULTS A total of 253 (27.4%) patients had some type of cardiac conduction defects on standard ECGs (defined as at least one heart block among first-degree atrioventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block). Prevalence of patients with eGFRCKD-EPI < 30 mL/min/1.73 m2, eGFRCKD-EPI 59-30 mL/min/1.73 m2 or abnormal albuminuria (i.e. urinary albumin-to-creatinine ratio ≥ 30 mg/g) were 7.0%, 29.4% and 41.3%, respectively. After adjustment for known cardiovascular risk factors, diabetes-related variables and potential confounders, there was a significant, graded association between decreasing eGFR values and risk of any cardiac conduction defects [adjusted-odds ratios of 2.05 (95% CI: 1.2-3.5), 2.85 (95% CI: 1.6-5.1) and 3.62 (95% CI: 1.6-8.1) for eGFRCKD-EPI 89-60, eGFRCKD-EPI 59-30 and eGFRCKD-EPI < 30 mL/min/1.73 m2, respectively]. Conversely, abnormal albuminuria was not independently associated with an increased risk of any conduction defects (adjusted-odds ratio: 1.09, 95% CI: 0.7-1.6). CONCLUSION Decreasing eGFR is independently associated with an increased risk of cardiac conduction defects in hospitalized patients with T2DM.
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11
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Palanca A, Castelblanco E, Perpiñán H, Betriu À, Soldevila B, Valdivielso JM, Bermúdez M, Duran X, Fernández E, Puig-Domingo M, Groop PH, Alonso N, Mauricio D. Prevalence and progression of subclinical atherosclerosis in patients with chronic kidney disease and diabetes. Atherosclerosis 2018; 276:50-57. [PMID: 30032025 DOI: 10.1016/j.atherosclerosis.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and diabetes. Traditional cardiovascular risk factors fail to fully account for the increase in cardiovascular risk in these patients. This study aims to analyse the prevalence and progression of subclinical atherosclerosis in CKD patients with and without diabetes. METHODS We included data from CKD patients with and without diabetes free from previous cardiovascular events from the NEFRONA cohort. Patients underwent baseline and 24-month follow-up carotid and femoral ultrasound examinations. Multivariable models were used to assess the contribution of diabetes to the presence and plaque progression. RESULTS A total of 419 patients with diabetes and 1129 without diabetes were included. Diabetic patients were older, had higher BMIs, more hypertension and dyslipidaemia. At baseline, the proportion of patients with plaque was higher among diabetic patients (81.4% vs. 64.1%, p < 0.001). Diabetic patients more frequently had more than two vascular territories with plaque (64.4% vs. 48.4%, p < 0.001). Multivariable analysis indicated that plaque at baseline was significantly associated with age, gender, smoking and renal replacement therapy (RRT) in the non-diabetic patients, but only with age and male gender in diabetic patients. Plaque progression was significantly associated with age, number of territories with basal plaque, smoking and RRT in both groups. CONCLUSIONS Subclinical atherosclerosis is more prevalent, carries a higher plaque burden and is more rapidly progressive in renal patients with diabetes. In these patients, diabetes outweighs other described risk factors associated with the presence of subclinical atherosclerosis.
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Affiliation(s)
- Ana Palanca
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - Hèctor Perpiñán
- Biostatistics Unit, Institut de Recerca Biomèdica de Lleida, Spain
| | - Àngels Betriu
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Berta Soldevila
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Marcelino Bermúdez
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Xavier Duran
- Methodological and Biostatistical Advisory Service, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain.
| | - Dídac Mauricio
- Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain; Department of Endocrinology and Nutrition, University Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.
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12
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Guo M, Niu JY, Ye XW, Han XJ, Zha Y, Hong Y, Fang H, Gu Y. Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus. Clin Interv Aging 2017; 12:1661-1672. [PMID: 29070944 PMCID: PMC5640414 DOI: 10.2147/cia.s140289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical assessment of kidney function based on the estimated glomerular filtration rate (GFR) in older patients remains controversial. This study evaluated the concordance and feasibility of using various creatinine-based equations for estimating GFR in elderly Chinese patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional analytical study was conducted in 21,723 older diabetic patients (≥60 years) based on electronic health records (EHR) for Minhang District, Shanghai, China. The concordance of chronic kidney disease (CKD) classification among different creatinine-based equations was assessed based on Kappa values, intraclass correlation coefficient (ICC) statistics, and the eGFR agreement between the equations was tested using Bland-Altman plots. The GFR was estimated using the Cockcroft-Gault (CG), Berlin Initiative Study 1 (BIS1), simplified Modification of Diet in Renal Disease (MDRD), MDRD modified for Chinese populations (mMDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), CKD-EPI in Asians (CKD-EPI-Asia), and Ruijin equations. RESULTS Overall, the proportion of CKD stages 3-5 (eGFR <60 mL/min/1.73 m2) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFRCG, eGFRBIS1, eGFRMDRD, eGFRmMDRD, eGFRCKD-EPI, eGFRCKD-EPI-Asia, and eGFRRuijin equations, respectively. The concordance of albuminuria and decreased eGFR based on the different equations was poor by both the Kappa (<0.2) and ICC (<0.4) statistics. The CKD-EPI-Asia equation resulted in excellent concordance with the CKD-EPI (ICC =0.931), MDRD (ICC =0.963), mMDRD (ICC =0.892), and Ruijin (ICC =0.956) equations for the classification of CKD stages, whereas the BIS1 equation exhibited good concordance with the CG equation (ICC =0.809). In addition, significant differences were observed for CKD stage 1 among all these equations. CONCLUSION Accurate GFR values are difficult to estimate using creatinine-based equations in older diabetic patients. Kidney function is complex, and the staff need to be aware of the individualized consideration of other risk factors or markers of reduced renal function in clinical practice.
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Affiliation(s)
- Mei Guo
- Zhongshan-Xuhui Hospital, Affiliated with Fudan University
| | - Jian-Ying Niu
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Xian-Wu Ye
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Xiao-Jie Han
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Ying Zha
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Yang Hong
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Hong Fang
- Shanghai Minhang Center for Disease Control and Prevention
| | - Yong Gu
- The Fifth People's Hospital of Shanghai, Fudan University.,Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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13
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Mantovani A, Rigolon R, Pichiri I, Bonapace S, Morani G, Zoppini G, Bonora E, Targher G. Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus. PLoS One 2017; 12:e0185459. [PMID: 28981521 PMCID: PMC5628831 DOI: 10.1371/journal.pone.0185459] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiac tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus. The aim of this study was to examine whether an association also exists between NAFLD and heart block. We have retrospectively evaluated a hospital-based cohort of 751 patients with type 2 diabetes discharged from our Division of Diabetes and Endocrinology during years 2007–2014. Standard electrocardiograms were performed on all patients. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced hepatic fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis markers. Overall, 524 (69.8%) patients had NAFLD and 202 (26.9%) had heart block (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block) on electrocardiograms. Patients with NAFLD had a remarkably higher prevalence of any persistent heart block than those without NAFLD (31.3% vs. 16.7%, p<0.001); this prevalence was particularly increased among those with higher FIB-4 score. NAFLD was associated with a threefold increased risk of prevalent heart block (adjusted-odds ratio 3.04, 95% CI 1.81–5.10), independently of age, sex, hypertension, prior ischemic heart disease, hemoglobin A1c, microvascular complication status, use of medications and other potentially confounding factors. In conclusion, this is the largest cross-sectional study to show that NAFLD and its severity are independently associated with an increased risk of prevalent heart block in hospitalized patients with type 2 diabetes.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Riccardo Rigolon
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, ‘‘Sacro Cuore” Hospital, Negrar, Verona, Italy
| | - Giovanni Morani
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
- * E-mail:
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14
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Schwandt A, Denkinger M, Fasching P, Pfeifer M, Wagner C, Weiland J, Zeyfang A, Holl RW. Comparison of MDRD, CKD-EPI, and Cockcroft-Gault equation in relation to measured glomerular filtration rate among a large cohort with diabetes. J Diabetes Complications 2017; 31:1376-1383. [PMID: 28711195 DOI: 10.1016/j.jdiacomp.2017.06.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 01/05/2023]
Abstract
AIMS To analyze the performance of Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault (CG), and CG calculated with ideal bodyweight (CG-IBW) equations to estimate glomerular filtration rate (eGFR) based on serum creatinine in a large diabetic population. METHODS 24,516 adults with type-1-diabetes or type-2-diabetes from the multicenter diabetes prospective follow-up registry DPV were analyzed. We compared eGFR and measured GFR (mGFR) based on 24-h urine collection by calculating mean bias (difference), precision (SD of this difference), accuracy (proportion of eGFR within ±10% of mGFR), Bland-Altman-plots. RESULTS CG overestimates, whereas MDRD, CKD-EPI, and CG-IBW underestimate. Smallest mean bias and highest accuracy (75.3%) were observed for MDRD compared to the other equations (p<0.0001). MDRD and CKD-EPI estimated most accurately in stages 1 (MDRD:57.7%, CKD-EPI:57.3%) and 2 (MDRD:80.2%, CKD-EPI:80.7%). In stages 3 to 5, highest accuracy was observed for the MDRD (stage 3:82.3%, stage 4:77.8%, stage 5:71.0%). Among younger subjects, accuracy was higher using the CKD-EPI (18-<40years:63.7%, 40-<60years:72.8%). Above age 60years, MDRD estimated most accurately (60-<70years:77.3%, ≥70years:78.8%). In males and females, MDRD estimated most accurately (males:75.3%, females:75.3%). CONCLUSION In this large diabetic cohort, smallest bias and highest accuracy were observed for the MDRD.
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Affiliation(s)
- Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, 89081 Ulm, Germany; German Center for Diabetes Research (DZD), 85764 Munich, Neuherberg, Germany.
| | - Michael Denkinger
- Geriatric Center Ulm/Alb-Donau, Geriatric Medicine at Ulm University, Agaplesion Bethesda Hospital Ulm, 89081 Ulm, Germany
| | - Peter Fasching
- 5th Medical Department, Wilhelminenspital, 1116 Vienna, Austria
| | - Martin Pfeifer
- Diabetes Center, Clinic Tettnang, 88069 Tettnang, Germany
| | | | - Jörg Weiland
- Department of Internal Medicine, Hospital Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Andrej Zeyfang
- Sana Hospital Bethesda Stuttgart, 70184 Stuttgart, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, 89081 Ulm, Germany; German Center for Diabetes Research (DZD), 85764 Munich, Neuherberg, Germany
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15
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Lee CH, Shih AZL, Woo YC, Fong CHY, Yuen MMA, Chow WS, Lam KSL. Which creatinine-based estimated glomerular filtration rate equation best predicts all-cause mortality in Chinese subjects with type 2 diabetes? Diabetes Res Clin Pract 2017; 126:25-29. [PMID: 28189951 DOI: 10.1016/j.diabres.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/20/2017] [Indexed: 11/19/2022]
Abstract
AIM In Chinese, ethnicity-based and/or diabetes specific modifications of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have been developed for determining estimated glomerular filtrate rate (eGFR). This study aimed to compare the performance of five different creatinine-based eGFR equations in predicting all-cause mortality among Chinese subjects with type 2 diabetes (T2DM). METHODS A total of 6739 Chinese subjects with T2DM were included. Their eGFR was calculated using the MDRD, CKD-EPI, their respective modified equations for Chinese, and the diabetes specific CKD-EPI Chinese T2DM equations. Multiple Cox regression analysis was used to evaluate the associations of eGFR with all-cause mortality. C-statistics, net reclassification index (NRI) and integrated discrimination index (IDI) were applied to assess the discrimination and reclassification of each eGFR equation in predicting mortality outcome. RESULTS Over a follow-up of 5.7years, the incidence of all-cause mortality was 12.9% (N=867). The CKD-EPI equation discriminated all-cause mortality better than the MDRD equation (C-statistics: 0.714 vs. 0.689, p<0.0001), and Chinese modification of their respective equations did not improve discrimination. Among the five eGFR equations evaluated, the CKD-EPI Chinese T2DM equation provided the best discrimination in predicting all-cause mortality among Chinese subjects with T2DM, and was the only equation providing a significantly positive NRI and IDI relative to the CKD-EPI equation. CONCLUSIONS Among Chinese subjects with T2DM, our findings suggested that the CKD-EPI Chinese T2DM equation best predicted all-cause mortality, and relative to the CKD-EPI equation, conferred improved discrimination and reclassification.
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Affiliation(s)
- C H Lee
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - A Z L Shih
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Y C Woo
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - C H Y Fong
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - M M A Yuen
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - W S Chow
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - K S L Lam
- Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region.
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16
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Salinero-Fort MÁ, San Andrés-Rebollo FJ, de Burgos-Lunar C, Abánades-Herranz JC, Carrillo-de-Santa-Pau E, Chico-Moraleja RM, Jiménez-García R, López-de-Andrés A, Gómez-Campelo P. Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: Association with chronic kidney disease. J Diabetes Complications 2016; 30:227-36. [PMID: 26627635 DOI: 10.1016/j.jdiacomp.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
AIMS To assess the prevalence of stage 3-5 chronic kidney disease (CKD) at baseline and to identify associated risk factors. To determine the effect of CKD and CKD stage according to estimated glomerular filtration rate (eGFR) and albuminuria categories on all-cause and cardiovascular mortality after a 5-year follow-up. METHODS Prospective cohort study of 3443 outpatients with type 2 diabetes mellitus. RESULTS The prevalence of CKD was 28.32% (95% CI, 26.84-29.86); and variables most strongly associated were: age >74 years (OR, 19.88; 95% CI, 12.89-30.68) and albuminuria (OR, 2.27; 95% CI, 1.72-3.00). During follow-up, 221 CKD patients (22.90%) died compared with 203 non-CKD patients (8.31%) (p<0.01). The adjusted HR of CKD for cardiovascular and all-cause mortality was 1.82 (95% CI, 1.36-2.44) and 2.11 (95% CI, 1.61-2.76) for those with LDL cholesterol =135 mg/dl, respectively. The adjusted HR of very-high-risk CKD for all-cause mortality was 4.44 (95% CI, 2.31-8.53) in aged <75 years and 1.80 (95% CI, 1.19-2.72) in aged ≥75 years. CONCLUSIONS CKD at baseline is an independent risk factor for all-cause and cardiovascular mortality in the overall cohort, men and women, or in primary and secondary prevention of coronary heart disease. Albuminuria is an independent risk factor for all-cause and cardiovascular mortality only in primary prevention.
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Affiliation(s)
- Miguel Ángel Salinero-Fort
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | | | - Carmen de Burgos-Lunar
- Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario La Paz, Servicio Madrileño de Salud, Madrid, Spain
| | - Juan Carlos Abánades-Herranz
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | | | | | | | - Ana López-de-Andrés
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paloma Gómez-Campelo
- Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Plataforma de Apoyo al Investigador Novel-PAIN Platform, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
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17
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Zhao F, Zhang L, Lu J, Guo K, Wu M, Yu H, Zhang M, Bao Y, Chen H, Jia W. The Chronic Kidney Disease Epidemiology Collaboration equation improves the detection of hyperfiltration in Chinese diabetic patients. Int J Clin Exp Med 2015; 8:22084-22097. [PMID: 26885183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Hyperfiltration confers an increased risk of diabetic nephropathy. Early detection can ensure timely intervention and improved treatment outcomes. Because GFR is known to be affected by hyperglycemia, the aim of this study was to compare the influence of hyperglycemia on GFR estimations calculated by the CKD-EPI equation, the CG equation, and the MDRD equations in estimating hyperfiltration in Chinese diabetic patients. MATERIALS AND METHODS The performance of the equations, compared with the measured (99)mTc-DTPA glomerular filtration rate was analyzed in 3492 diabetic patients. Bias, precision, and accuracies were compared with respect to HbA1c status. The Bland-Altman method was used to evaluate the agreement among the equations with respect to the mGFR, and the receiver-operating characteristic curve method was used to evaluate diagnostic value of the three equations with respect to the detection of moderate renal failure and hyperfiltration. RESULTS The mean absolute bias was the smallest for the CKD-EPI equation in the HbA1c < 7.2% cohort, and the highest accuracy within ± 15% and ± 30% was also reached with the CKD-EPI equation in both cohorts. For the detection of hyperfiltration, the CKD-EPI equation exhibited the best performance with the greatest combination of sensitivity and specificity. The biases of the three equations were significantly higher in the HbA1c ≥ 10.5% subgroup compared with the HbA1c < 7.2% cohort. CONCLUSION The CKD-EPI equation can be used as a screening tool for hyperfiltration and appears to be a more generalizable and accurate equation for estimating GFR in Chinese diabetic patients.
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Affiliation(s)
- Fangya Zhao
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Lei Zhang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Junxi Lu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Kaifeng Guo
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Mian Wu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Mingliang Zhang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233, China
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18
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Salvotelli L, Stoico V, Perrone F, Cacciatori V, Negri C, Brangani C, Pichiri I, Targher G, Bonora E, Zoppini G. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program. J Diabetes Complications 2015; 29:1066-70. [PMID: 26227575 DOI: 10.1016/j.jdiacomp.2015.06.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Abstract
AIMS Somatic neuropathy is a chronic complication of diabetes. The purpose of our study was to determine prevalence and clinical variables associated with somatic neuropathy applying a simple screening method. METHODS All outpatients with type 2 diabetes attending our diabetic clinic were offered to participate into a diabetic foot screening program, in the period January 2004-December 2012. A total of 3,591 diabetic patients (55.5% men, age 68±10years) underwent detection of somatic neuropathy using the Michigan Neuropathy Screening Instrument in its parts of symptoms (administering a questionnaire) and clinical assessment slightly modified (evaluating foot inspection, vibration sensation by biothesiometer, ankle reflexes). RESULTS The prevalence of somatic neuropathy was 2.2% in men and 5.5% in women (p<0.001) when assessed by symptom questionnaire, whereas it was 30.5% in men and 30.8% (p=NS) in women when identified by clinical assessment. In subjects with somatic neuropathy macro- and microvascular complications of diabetes were significantly more common. In multivariate logistic regression analyses BMI, HbA1c and ankle/brachial index independently predicted the presence of neuropathy. CONCLUSION The prevalence of somatic neuropathy in type 2 diabetes is nearly 30% when searched with clinical examination. Poor metabolic control, excess body weight and peripheral arteriopathy are independent markers of somatic neuropathy.
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Affiliation(s)
- Laura Salvotelli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Vincenzo Stoico
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Fabrizia Perrone
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Vittorio Cacciatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Corinna Brangani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Isabella Pichiri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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Fabbian F, De Giorgi A, Monesi M, Pala M, Tiseo R, Forcellini S, Storari A, Graziani R, Volpi R, Mikhailidis DP, Manfredini R. A possible relationship between renal impairment and complications development in type 2 diabetes mellitus: a prospective, observational study in Italy. J Diabetes Complications 2015; 29:771-5. [PMID: 26025698 DOI: 10.1016/j.jdiacomp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND We investigated the relationship between complications development and estimated glomerular filtration rate (eGFR), in a cohort of type 2 diabetes mellitus (T2DM) outpatients. METHODS This observational study considered 1284 T2DM outpatients, who had been followed-up for 4.5 ± 1.6 years. eGFR was estimated using Chronic Kidney Disease Epidemiology Collaboration equation. The independent relationship between development of complications and clinical data was evaluated, and hazard ratio (HR) by Cox regression analysis calculated. RESULTS Mean age of the population was 66.8 ± 10.4 years; mean serum creatinine and eGFR were 1.05 ± 0.36 mg/dl and 71.6 ± 21.6 ml/min/1.73 m(2), respectively. Complications including death (14.2% of the whole population) were recorded in 504 subjects (39.3%). Patients with complications were older and more frequently male with history of hypertension, coronary heart disease, congestive heart disease, retinopathy, nephropathy and had higher levels of glycated hemoglobin. At Cox regression analysis, eGFR was the major risk factor for development of complications, and the HR increased according with lower eGFR (HR 1.53 and 1.86, for eGFR<45 and<30 ml/min/1.73 m(2), respectively). CONCLUSIONS In our cohort of T2DM outpatients, a reduced eGFR was associated with an increased risk of complications development.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara.
| | - Alfredo De Giorgi
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Marcello Monesi
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Marco Pala
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Ruana Tiseo
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | | | - Alda Storari
- Nephrology and Dialysis, University Hospital St. Anna, Ferrara
| | - Roberto Graziani
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Riccardo Volpi
- Department of Internal Medicine and Biomedical Science, University of Parma, Parma
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London Medical School, University College London (UCL), London, UK
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
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Douros A, Ebert N, Jakob O, Martus P, Kreutz R, Schaeffner E. Estimating kidney function and use of oral antidiabetic drugs in elderly. Fundam Clin Pharmacol 2015; 29:321-8. [DOI: 10.1111/fcp.12118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/16/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Antonios Douros
- Department of Clinical Pharmacology and Toxicology; Charité-Universitätsmedizin Berlin; Charitéplatz 1 10117 Berlin Germany
- Department of Clinical Epidemiology; Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH; Bremen Germany
| | - Natalie Ebert
- Department of Nephrology and Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Augustenburgerplatz 1 13353 Berlin Germany
| | - Olga Jakob
- Institute for Biostatistics and Clinical Epidemiology; Charité-Universitätsmedizin Berlin; Hindenburgdamm 30 12203 Berlin Germany
| | - Peter Martus
- Institute for Biostatistics and Clinical Epidemiology; Charité-Universitätsmedizin Berlin; Hindenburgdamm 30 12203 Berlin Germany
| | - Reinhold Kreutz
- Department of Clinical Pharmacology and Toxicology; Charité-Universitätsmedizin Berlin; Charitéplatz 1 10117 Berlin Germany
| | - Elke Schaeffner
- Department of Nephrology and Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Augustenburgerplatz 1 13353 Berlin Germany
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21
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Fabbian F, De Giorgi A, Monesi M, Pala M, Tiseo R, Misurati E, Parisi C, Volpi R, Graziani R, Mikhailidis DP, Manfredini R. All-cause mortality and estimated renal function in type 2 diabetes mellitus outpatients: Is there a relationship with the equation used? Diab Vasc Dis Res 2015; 12:46-52. [PMID: 25344129 DOI: 10.1177/1479164114552656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We investigated the relationship between serum creatinine (SCr) and estimated glomerular filtration rate (eGFR), evaluated by different formulae, and all-cause mortality (ACM) in type 2 diabetes mellitus (T2DM) outpatients. METHODS This observational cohort study considered 1365 T2DM outpatients, who had been followed up for a period of up to 11 years. eGFR was estimated using several equations. RESULTS Seventy subjects (5.1%) died after a follow-up of 9.8 ± 3 years. Univariate analysis showed that diagnosis of nephropathy (odds ratio (OR): 2.554, 95% confidence interval (CI): 1.616-4.038, p < 0.001) and microvascular complications (OR: 2.281, 95% CI: 1.449-3.593, p < 0.001) were associated with ACM. Receiving operating characteristic (ROC) curves showed that the areas under the curve for ACM were similar using the different eGFR equations. eGFR values were predictors of ACM, and the hazard ratios (HRs) of the different equations for eGFR estimation were similar. CONCLUSION In our cohort of T2DM outpatients, different eGFR equations perform similarly in predicting ACM, whereas SCr did not.
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Affiliation(s)
- Fabio Fabbian
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Alfredo De Giorgi
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Marcello Monesi
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara, Italy
| | - Marco Pala
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Ruana Tiseo
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Elisa Misurati
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Claudia Parisi
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
| | - Riccardo Volpi
- Department of Internal Medicine and Biomedical Science, University of Parma, Parma, Italy
| | - Roberto Graziani
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London Medical School, University College London (UCL), London, UK
| | - Roberto Manfredini
- Operative Unit of Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara, Italy
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Almualm Y, Zaman Huri H. Chronic kidney disease screening methods and its implication for Malaysia: an in depth review. Glob J Health Sci 2015; 7:96-109. [PMID: 25946939 PMCID: PMC4802081 DOI: 10.5539/gjhs.v7n4p96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022] Open
Abstract
Chronic Kidney Disease has become a public health problem, imposing heath, social and human cost on societies worldwide. Chronic Kidney Disease remains asymptomatic till late stage when intervention cannot stop the progression of the disease. Therefore, there is an urgent need to detect the disease early. Despite the high prevalence of Chronic Kidney Disease in Malaysia, screening is still lacking behind. This review discusses the strengths and limitations of current screening methods for Chronic Kidney Disease from a Malaysian point of view. Diabetic Kidney Disease was chosen as focal point as Diabetes is the leading cause of Chronic Kidney Disease in Malaysia. Screening for Chronic Kidney Disease in Malaysia includes a urine test for albuminuria and a blood test for serum creatinine. Recent literature indicates that albuminuria is not always present in Diabetic Kidney Disease patients and serum creatinine is only raised after substantial kidney damage has occurred. Recently, cystatin C was proposed as a potential marker for kidney disease but this has not been studied thoroughly in Malaysia. Glomerular Filtration Rate is the best method for measuring kidney function and is widely estimated using the Modification of Diet for Renal Disease equation. Another equation, the Chronic Kidney Disease Epidemiology Collaboration Creatinine equation was introduced in 2009. The new equation retained the precision and accuracy of the Modification of Diet for Renal Disease equation at GFR < 60ml/min/1.73m2, showed less bias and improved precision at GFR>60ml/min/1.73m2. In Asian countries, adding an ethnic coefficient to the equation enhanced its performance. In Malaysia, a multi-ethnic Asian population, the Chronic Kidney Disease Epidemiology Collaboration equation should be validated and the Glomerular Filtration Rate should be reported whenever serum creatinine is ordered. Reporting estimated Glomerular Filtration Rate will help diagnose patients who would have been otherwise missed if only albuminuria and serum creatinine are measured.
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Affiliation(s)
- Yasmin Almualm
- 1- (currently)Department of Community Health, Faculty of Medicine, National University of Malaysia 2- (at the time research was conducted ) Clinical Investigation Centre, Faculty of Medicine , University of Malaya.
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Wang X, Luo Y, Wang Y, Wang C, Zhao X, Wang D, Liu L, Liu G, Wang Y. Comparison of Associations of Outcomes After Stroke With Estimated GFR Using Chinese Modifications of the MDRD Study and CKD-EPI Creatinine Equations: Results From the China National Stroke Registry. Am J Kidney Dis 2014; 63:59-67. [DOI: 10.1053/j.ajkd.2013.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 08/06/2013] [Indexed: 11/11/2022]
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Lee EY, Lee YM, Choi KH, Lee HC, Lee BW, Kim BS. Comparison of two creatinine-based equations for predicting decline in renal function in type 2 diabetic patients with nephropathy in a korean population. Int J Endocrinol 2013; 2013:848963. [PMID: 24454370 PMCID: PMC3884626 DOI: 10.1155/2013/848963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
Aim. To compare two creatinine-based estimated glomerular filtration rate (eGFR) equations, the chronic kidney disease epidemiology collaboration (CKD-EPI) and the modification of diet in renal disease (MDRD), for predicting the risk of CKD progression in type 2 diabetic patients with nephropathy. Methods. A total of 707 type 2 diabetic patients with 24 hr urinary albumin excretion of more than 30 mg/day were retrospectively recruited and traced until doubling of baseline serum creatinine (SCr) levels was noted. Results. During the follow-up period (median, 2.4 years), the CKD-EPI equation reclassified 10.9% of all MDRD-estimated subjects: 9.1% to an earlier stage of CKD and 1.8% to a later stage of CKD. Overall, the prevalence of CKD (eGFR < 60 mL/min/1.73 m(2)) was lowered from 54% to 51.6% by applying the CKD-EPI equation. On Cox-regression analysis, both equations exhibited significant associations with an increased risk for doubling of SCr. However, only the CKD-EPI equation maintained a significant hazard ratio for doubling of SCr in earlier-stage CKD (eGFR ≥ 45 mL/min/1.73 m(2)), when compared to stage 1 CKD (eGFR ≥ 90 mL/min/1.73 m(2)). Conclusion. In regard to CKD progression, these results suggest that the CKD-EPI equation might more accurately stratify earlier-stage CKD among type 2 diabetic patients with nephropathy than the MDRD study equation.
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Affiliation(s)
- Eun Young Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Young-Mi Lee
- Department of Internal Medicine, Dongtan Jeil Women's Hospital, 42-1 Seokwoo-dong, Hwasung, Gyeonggi-do 445-170, Republic of Korea
| | - Kyu Hun Choi
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hyun Chul Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- *Byung-Wan Lee: and
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- *Beom Seok Kim:
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