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Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus
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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640414/ https://www.ncbi.nlm.nih.gov/pubmed/29070944 http://dx.doi.org/10.2147/CIA.S140289 |
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author | Guo, Mei Niu, Jian-Ying Ye, Xian-Wu Han, Xiao-Jie Zha, Ying Hong, Yang Fang, Hong Gu, Yong |
author_facet | Guo, Mei Niu, Jian-Ying Ye, Xian-Wu Han, Xiao-Jie Zha, Ying Hong, Yang Fang, Hong Gu, Yong |
author_sort | Guo, Mei |
collection | PubMed |
description | 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 m(2)) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFR(CG), eGFR(BIS1), eGFR(MDRD), e(GFRmMDRD), e(GFRCKD-EPI), e(GFRCKD-EPI-Asia), and e(GFRRuijin) 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. |
format | Online Article Text |
id | pubmed-5640414 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-56404142017-10-25 Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus Guo, Mei Niu, Jian-Ying Ye, Xian-Wu Han, Xiao-Jie Zha, Ying Hong, Yang Fang, Hong Gu, Yong Clin Interv Aging Original Research 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 m(2)) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFR(CG), eGFR(BIS1), eGFR(MDRD), e(GFRmMDRD), e(GFRCKD-EPI), e(GFRCKD-EPI-Asia), and e(GFRRuijin) 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. Dove Medical Press 2017-10-09 /pmc/articles/PMC5640414/ /pubmed/29070944 http://dx.doi.org/10.2147/CIA.S140289 Text en © 2017 Guo et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Guo, Mei Niu, Jian-Ying Ye, Xian-Wu Han, Xiao-Jie Zha, Ying Hong, Yang Fang, Hong Gu, Yong Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title | Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title_full | Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title_fullStr | Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title_full_unstemmed | Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title_short | Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus |
title_sort | evaluation of various equations for estimating renal function in elderly chinese patients with type 2 diabetes mellitus |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640414/ https://www.ncbi.nlm.nih.gov/pubmed/29070944 http://dx.doi.org/10.2147/CIA.S140289 |
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