Estimating Glomerular Filtration Rate Calculated by Serum Creatinine Lacks Precision and Accuracy in Adults with Type 2 Diabetes with Preserved Renal Function
| العنوان: | Estimating Glomerular Filtration Rate Calculated by Serum Creatinine Lacks Precision and Accuracy in Adults with Type 2 Diabetes with Preserved Renal Function |
|---|---|
| المؤلفون: | David Z.I. Cherney, Harindra Rajasekeran, Bruce A. Perkins, Yuliya Lytvyn, Daniel Scarr, Leif E. Lovblom, Petter Bjornstad, Julie A. Lovshin |
| المصدر: | Diabetes. 67 |
| بيانات النشر: | American Diabetes Association, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | medicine.medical_specialty, Inulin Clearance, Creatinine, business.industry, Endocrinology, Diabetes and Metabolism, Renal function, Context (language use), Type 2 diabetes, Dipeptidyl peptidase-4 inhibitor, medicine.disease, Placebo, chemistry.chemical_compound, chemistry, Sitagliptin, Internal medicine, Internal Medicine, medicine, business, medicine.drug |
| الوصف: | We evaluated the performance of creatinine-based estimating equations for glomerular filtration rate (GFR) in adults with type 2 diabetes without nephropathy compared to measured GFR by gold-standard inulin clearance methods. mGFR was performed 4 times over the course of a 1 month treatment period in the context of a small randomized placebo-controlled trial measuring the intrarenal hemodynamics function responses to the dipeptidyl peptidase 4 inhibitor sitagliptin. Thirty-two adults with type 2 diabetes (randomized 1:1 to placebo or sitagliptin) completed the trial, and all participants underwent mGFR by inulin clearance and GFR estimated by serum creatinine using the MDRD (eGFRMDRD) and CKD-EPI (eGFRCKD-EPI). Performance of eGFR equations was evaluated using measurements of bias (mean difference), precision (standard deviations [SD]), and inaccuracy (defined as the proportion of eGFR that differed by >20% of mGFR). The effects of treatment and time on bias were evaluated using linear mixed effects models. Mean±SD age, diabetes duration, HbA1c, and BMI was 60±8 years, 9±7 years, 7.2±0.8%, and 31.0±6.2 kg/m2, respectively, and 12(38%) participants were female. At baseline, mean mGFR was 113±24, mean eGFRMDRD was 93±12, and mean eGFRCKD-EPI was 94±9, all in mL/min/1.73m2. When all 128 observations (32 participants measured 4 times) were evaluated, both equations substantially underestimated mGFR. For the eGFRMDRD, mean bias was -21.5 mL/min/1.73m2, precision was 22.7 mL/min/1.73m2, and 46% of observations differed by more than 20%. Results were similar for eGFRCKD-EPI. No time or treatment effects on bias were observed. In adults with type 2 diabetes, eGFR equations underestimated mGFR, lacked precision and accuracy, and had lower performance at higher ranges of mGFR. More accurate measures of kidney function may improve clinical decision-making in adults with type 2 diabetes. Disclosure J.A. Lovshin: Other Relationship; Self; AstraZeneca. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi, Merck Sharp & Dohme Corp.. Other Relationship; Self; Novo Nordisk Inc.. L. Lovblom: None. P. Bjornstad: Consultant; Self; Boehringer Ingelheim GmbH. Y. Lytvyn: None. H. Rajasekeran: None. D. Scarr: None. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc. D. Cherney: Consultant; Self; AbbVie Inc.. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company. Consultant; Self; Sanofi. Other Relationship; Self; Merck & Co., Inc.. Consultant; Self; Mitsubishi Tanabe Pharma Corporation. Other Relationship; Self; Janssen Pharmaceuticals, Inc.. |
| تدمد: | 1939-327X 0012-1797 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::0e46859ad55280101e3a26db03122b61Test https://doi.org/10.2337/db18-537-pTest |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi...........0e46859ad55280101e3a26db03122b61 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1939327X 00121797 |
|---|