Comparative performance of four equations estimating glomerular filtration rate in adult Chinese diabetics

The Chronic Kidney Disease Epidemiology Collaboration equations perform less well in an older population with type 2 diabetes than their non-diabetic counterparts

Objectives

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations are based on creatinine alone (CKD-EPIcr), cystatin C alone (CKD-EPIcys) and combined creatinine and cystatin C (CKD-EPIcr-cys). It remains unclear whether these equations perform differently in older adults with type 2 diabetes than they do in non-diabetic older individuals.

Methods

This single-center cross-sectional study was performed in adults aged ≥ 65 years between January 2019 and December 2021. Glomerular filtration rate (GFR) was measured by technetium-99m-diethylene triamine pentaacetic acid (^99mTc-DTPA) renal dynamic imaging. The bias (difference between measured and estimated GFR), precision [interquartile range (IQR) of the median difference between measured GFR and estimated GFR] and accuracy P30 (percentage of estimated GFR within 30% of measured GFR) were considered the criteria of equation performance.

Results

Finally, 476 participants were enrolled, including 243 adults with type 2 diabetes and 233 non-diabetic adults. The mean age of the included participants was 71.69 ± 6.4 years and 262 (55%) were male. The mean measured GFR was 49.02 ± 22.45 ml/min/1.73 m². The CKD-EPIcr-cys equation showed significantly greater bias and lower accuracy (P30) in individuals with diabetes than in the non-diabetic group (median bias, 4.08 vs. 0.41 ml/min/1.73 m², respectively, p < 0.05; P30, 63.78% vs. 78.54%, respectively, p < 0.05). The precision IQR indicated that CKD-EPIcr-cys had also lower precision in individuals with diabetes than in the non-diabetic controls (17.27 vs. 15.49 ml/min/1.73 m², respectively). Similar results were observed for CKD-EPIcr and CKD-EPIcys equations. The P30 of all three equations failed to reach 80% in diabetic and non-diabetic groups.

Conclusions

The performance of the CKD-EPI equations was lower in a group of patients aged ≥ 65 years with type 2 diabetes than in non-diabetic counterparts. However, each equation still had limitations regarding accuracy in older adults with or without diabetes.

The relationship between hypertriglyceridemic-waist phenotype and vitamin D status in type 2 diabetes

Background: The aim of the study was to explore the relationship between hypertriglyceridemic-waist (HTW) phenotype and vitamin D status in type 2 diabetes. Methods: A cross-sectional study was conducted in subjects with type 2 diabetes. This study enrolled 338 type 2 diabetic (190 males and 148 females). The HTW phenotype was defined as serum triglyceride concentrations ≥1.7 mmol/L and waist circumference ≥90 cm (male) and 85 cm (female). Multiple logistic regression models were used for modeling relationships between HTW phenotype and vitamin D status. Results: The prevalence of HTW phenotype was 36.4%. The prevalence of HTW phenotype was 10.5%, 27.2%, and 41.6% in type 2 diabetes with vitamin D sufficiency, vitamin D insufficiency, and vitamin D deficiency, respectively. In multiple logistic regression analysis, subjects with vitamin D deficiency were more likely to have HTW phenotype (OR=6.222, 95%CI: 1.307-29.620, P=0.022) compared with subjects with vitamin D sufficiency. Conclusions: There was a significant correlation between HTW phenotype and vitamin D status in type 2 diabetes.

Investigating Factors Associated with Depressive Symptoms of Chronic Kidney Diseases in China with Type 2 Diabetes

Aim. To assess the depressive symptoms status of chronic kidney diseases in Nantong, China, with type 2 diabetes and to identify factors associated with depressive symptoms. Methods. In this cross-sectional analytic study, 210 type 2 diabetic patients were recruited from the Second Affiliated Hospital of Nantong University. Depressive symptoms were assessed with the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The quality of life was measured with the RAND 36-Item Health Survey (SF-36). And the independent risk factors of depressive symptoms were assessed by using a stepwise forward model of logistic regression analysis. Results. The mean age of the study subjects was 57.66 years (SD: 11.68). Approximately 21.4% of subjects reported depressive symptoms (n = 45). Forward stepwise logistic regression analysis showed that female gender (P = 0.010), hypertension (P = 0.022), Stage IV (P = 0.003), and Stage V (P < 0.001) were significant risk factors for depressive symptoms. The quality of life of individuals with HAD-D score <11 was significantly better compared with individuals with HAD-D score ≥ 11. Conclusions. These results indicate that clinicians should be aware that female patients with chronic kidney diseases with T2DM in their late stage with hypertension are at a marked increased risk of depressive symptoms. Providing optimal care for the psychological health of this population is vital.