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NDT Advance Access first published online on May 15, 2006
This version published online on May 23, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl221
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received November 24, 2005
Accepted March 29, 2006

Original Article

Are prediction equations for glomerular filtration rate useful for the long-term monitoring of type 2 diabetic patients?

Néstor Fontseré 1 *, Isabel Salinas 2, Jordi Bonal 1, Beatriz Bayés 1, Joaquim Riba 3, Ferran Torres 4, Jose Rios 4, Ana Sanmartí 2, and Ramón Romero 1

1 Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
2 Department of Endocrinology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
3 Department of Nuclear Medicine, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
4 Biostatistics and Epidemiology Laboratory, Universidad Autónoma de Barcelona, Barcelona, Spain

* To whom correspondence should be addressed.
Néstor Fontseré, E-mail: 34989nfb{at}comb.es



  Abstract

Background. The aim of this study was to compare the accuracy of prediction equations [modification of diet in renal disease (MDRD), simplified MDRD, Cockcroft-Gault (CG), reciprocal of creatinine and creatinine clearance] in a cohort of patients with type 2 diabetes.

Methods. A total of 525 glomerular filtration rates (GFRs) using 125I-iothalamate were carried out over 10 years in 87 type 2 diabetic patients. Accuracy was evaluated at three levels of renal function according to the baseline values obtained with the isotopic method: hyperfiltration (GFR: >140 ml/min/1.73 m2; 140 isotopic determinations in 27 patients), normal renal function (GFR: 140-90 ml/min/1.73 m2; 294 isotopic determinations in 47 patients) and chronic kidney disease (CKD) stages 2-3 (GFR: 30-89 ml/min/1.73 m2; 87 isotopic determinations in 13 patients). The annual slope for GFR (change in GFR expressed as ml/min/year) was considered to ascertain the variability in the equations compared with the isotopic method during follow-up. Student's t-test was used to determine the existence of significant differences between prediction equations and the isotopic method (P < 0.05 with Bonferroni adjusted for five contrast tests).

Results. In the subgroup of patients with hyperfiltration, a GFR slope calculated with 125I-iothalamate -4.8 ± 4.7 ml/min/year was obtained. GFR slope in patients with normal renal function was -3.0 ± 2.3 ml/min/year. In both situations, all equations presented a significant underestimation compared with the isotopic GFR (P < 0.01; P < 0.05). In the subgroup of CKD stages 2-3, the slope for GFR with 125I-iothalamate was -1.4 ± 1.8 ml/min/year. The best prediction equation compared with the isotopic method proved to be MDRD with a slope for GFR of -1.4 ± 1.3 ml/min/year (P: NS) compared with the CG formula -1.0 ± 0.9 ml/min/year (P: NS). Creatinine clearance presented the greatest variability in estimation (P < 0.001).

Conclusions. In the normal renal function and hyperfiltration groups, none of the prediction equations demonstrated acceptable accuracy owing to excessive underestimation of renal function. In CKD stages 2-3, with mean serum creatinine ≥133 µmol/l (1.5 mg/dl), the MDRD equation can be used to estimate GFR during the monitoring and follow-up of patients with type 2 diabetes receiving insulin, anti-diabetic drugs or both.

Keywords: CKD stages 2-3; glomerular filtration rate; hyperfiltration; normal renal function; prediction equations; type 2 diabetic patients.
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