Abstract
Aim. To compare two creatinine-based estimated glomerular filtration rate (eGFR) equations, the chronic kidney disease epidemiology collaboration (CKD-EPI) and the modification of diet in renal disease (MDRD), for predicting the risk of CKD progression in type 2 diabetic patients with nephropathy. Methods. A total of 707 type 2 diabetic patients with 24 hr urinary albumin excretion of more than 30 mg/day were retrospectively recruited and traced until doubling of baseline serum creatinine (SCr) levels was noted. Results. During the follow-up period (median, 2.4 years), the CKD-EPI equation reclassified 10.9% of all MDRD-estimated subjects: 9.1% to an earlier stage of CKD and 1.8% to a later stage of CKD. Overall, the prevalence of CKD (eGFR < 60 mL/min/1.73 m2) was lowered from 54% to 51.6% by applying the CKD-EPI equation. On Cox-regression analysis, both equations exhibited significant associations with an increased risk for doubling of SCr. However, only the CKD-EPI equation maintained a significant hazard ratio for doubling of SCr in earlier-stage CKD (eGFR ≥ 45 mL/min/1.73 m2), when compared to stage 1 CKD (eGFR ≥ 90 mL/min/1.73 m2). Conclusion. In regard to CKD progression, these results suggest that the CKD-EPI equation might more accurately stratify earlier-stage CKD among type 2 diabetic patients with nephropathy than the MDRD study equation.
Highlights
An increasing prevalence of chronic kidney disease (CKD) is garnering greater concern worldwide [1]
In this retrospective cohort study, we extracted data from an electronic medical record (EMR) database of type 2 diabetic subjects with nephropathy in whom two or more serum creatinine measurements were made between July 2000 and September 2012 at Severance Hospital in Seoul, Korea
The present study demonstrated the superiority of the CKD-EPI equation over the modification of diet in renal disease (MDRD) study equation in identifying Korean type 2 diabetic subjects with nephropathy who were expected to show deteriorations in renal function
Summary
An increasing prevalence of chronic kidney disease (CKD) is garnering greater concern worldwide [1]. An outstanding crosssectional study including 32,208 patients with type 2 diabetes (T2D) from 33 countries revealed that the overall prevalence of micro- and macroalbuminuria was about 39% and 10%, respectively [5]. The prevalence of ESRD caused by diabetes is estimated to increase to 70% by the year 2015 [4]. T2D is well known as a leading cause of cardiovascular disease (CVD) and ESRD [6]. It is well established that CKD has been shown to be strongly related to increased risks of CVD-related hospitalization and mortality, as well as ESRD, even after adjusting cardiovascular risk factors [1, 7, 8].
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