NDT Advance Access originally published online on April 12, 2006
Nephrology Dialysis Transplantation 2006 21(6):1732-1733; doi:10.1093/ndt/gfl180
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Is the diagnosis of chronic kidney disease missed in diabetic women?
Email: vincent.rigalleau{at}wanadoo.frSir,
Middleton et al. [1] have pointed out the high prevalence of chronic kidney disease (CKD) in diabetes: 27.5% of their 7596 diabetic patients had an estimated (MDRD equation) glomerular filtration rate (GFR) below 60 ml/min/1.73 m2, and most of them were unrecognized using the recommended determination of serum creatinine and albumin excretion rate. Interestingly, the MDRD-based diagnosis of CKD was twice as frequent in women in this study. This prompted us to test whether the underestimation of normal GFR by the MDRD equation that we have noted in diabetic subjects [2], was more pronounced in women.
In 81 diabetic patients (51 men, 29 type 1, age: 58±15 years) with a measured GFR (51Cr-EDTA clearance) above 60 ml/min/1.73m2, we compared the MDRD estimation (four-variable version, as described by Middleton et al. [1]) with the measured GFR, before (paired t-test) and after categorizing the subjects according to gender (ANOVA and unpaired t-tests). Results are presented as mean ± SD.
The mean measured GFR was 90.4±27.1 ml/min/1.73 m2 (60.4–160). The mean MDRD was 71.4±21.6 (P < 0.0001 vs measured). Twenty-seven (33%) of the 81 patients had an MDRD estimation below 60. Fourteen (52%) were women, whereas 16 women (29.6%) had an MDRD estimation over 60 (P < 0.05 by chi square). The comparison between men and women is shown in the Table 1.
|
Although populations may differ, diabetic nephropathy is usually reported as more prevalent among men than women [3,4]. The more marked underestimation by the MDRD in women as we found, probably contributed to the gender difference reported by Middleton et al. [1]. The reason why the MDRD underestimates normal GFR to a larger extent in women is unclear, however, it should be borne in mind that the MDRD equation has been established by a multiple regression procedure, from the results of renal insufficient patients, including only 6% diabetic subjects [5]. It is more accurate than the widely used Cockcroft–Gault formula to diagnose and stratify CKD in diabetics [2], but in our opinion the underestimation of high GFR makes it an inappropriate tool for screening diabetic patients for nephropathy. In patients with normal renal function, the MDRD equation should be used with caution, which may lead to the wrong conclusions, as noted by epidemiological studies on the relation between renal function and cardiovascular risk factors [6].
Université de Bordeaux 2—Victor Segalen 33000 Bordeaux, France1 Nutrition-Diabétologie Hôpital Haut-Lévêque Avenue de Magellan 33600 Pessac2 Néphrologie3 Médecine Nucléaire Hôpital Pellegrin Place Amélie Raba-Léon 33000 Bordeaux France
Acknowledgments
We would like to thank Dr S. Jarman for the revision of the English manuscript.
Conflict of interest statement. None declared.
References
- Middleton RJ, Foley RN, Hegarty J et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant 2006; 21: 88–92
[Abstract/Free Full Text] - Rigalleau V, Lasseur C, Perlemoine C et al. Estimation of glomerular filtration rate in diabetic subjects, Cockcroft or MDRD formula? Diabetes Care 2005; 28: 838–843
[Abstract/Free Full Text] - Zhang L, Krzentowski G, Albert A, Lefebvre PJ. Factors predictive of nephropathy in DCCT type 1 diabetic patients with good or poor metabolic control. Diabet Med 2003; 20: 580–585[CrossRef][Medline]
- Kikuchi M, Matsumoto T, Ohashi Y. Risk factors for development of proteinuria in NIDDM analyzed by Poisson regression. J Diabet Complications 1991; 5: 128–130[Medline]
- Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–470
[Abstract/Free Full Text] - Verhave JC, Gansevoort RT, Hillege HL, De Zeeuw D, Curhan GC, De Jong PE. Drawbacks of the use of indirect estimates of renal function to evaluate the effect of risk factors on renal function. J Am Soc Nephrol 2004; 15: 1316–1322
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y. Maaravi, M. Bursztyn, R. Hammerman-Rozenberg, and J. Stessman Glomerular filtration rate estimation and mortality in an elderly population QJM, July 1, 2007; 100(7): 441 - 449. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||