Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Guo, Mei, Niu, Jian-Ying, Ye, Xian-Wu, Han, Xiao-Jie, Zha, Ying, Hong, Yang, Fang, Hong, Gu, Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
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
_version_ 1783271039917096960
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
work_keys_str_mv AT guomei evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT niujianying evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT yexianwu evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT hanxiaojie evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT zhaying evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT hongyang evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT fanghong evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus
AT guyong evaluationofvariousequationsforestimatingrenalfunctioninelderlychinesepatientswithtype2diabetesmellitus