Journal of Clinical Medicine (Sep 2019)
The Error of Estimated GFR in Type 2 Diabetes Mellitus
- Sergio Luis-Lima,
- Tomás Higueras Linares,
- Laura Henríquez-Gómez,
- Raquel Alonso-Pescoso,
- Angeles Jimenez,
- Asunción María López-Hijazo,
- Natalia Negrín-Mena,
- Candelaria Martín,
- Macarena Sánchez-Gallego,
- Sara Judith Galindo-Hernández,
- Raquel Socas Fernández del Castillo,
- Manuel Castilla-Marrero,
- Santiago Domínguez-Coello,
- Vanesa Vilchez de León,
- Rafael Valcárcel-Lopez,
- Nerea Insausti-Garmendia,
- Beatriz Escamilla,
- Sara Estupiñán,
- Patricia Delgado-Mallén,
- Ana-María Armas-Padrón,
- Domingo Marrero-Miranda,
- Ana González-Rinne,
- Rosa María Miquel Rodríguez,
- María Angeles Cobo-Caso,
- Laura Díaz-Martín,
- Federico González-Rinne,
- Alejandra González-Delgado,
- Marina López-Martínez,
- Alejandro Jiménez-Sosa,
- Armando Torres,
- Esteban Porrini
Affiliations
- Sergio Luis-Lima
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, 28040 Madrid, Spain
- Tomás Higueras Linares
- Centro de Salud Tejina, 38260 La Laguna, Tenerife, Spain
- Laura Henríquez-Gómez
- Endocrinology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Raquel Alonso-Pescoso
- Endocrinology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Angeles Jimenez
- Centro de Salud de Puerto de la Cruz- Casco Botánico, 38400 Puerto de la Cruz, Tenerife, Spain
- Asunción María López-Hijazo
- Centro de Salud de La Vera, 38400 Puerto de la Cruz, Tenerife, Spain
- Natalia Negrín-Mena
- Research Unit Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Candelaria Martín
- Centro de Salud de Puerto de la Cruz- Casco Botánico, 38400 Puerto de la Cruz, Tenerife, Spain
- Macarena Sánchez-Gallego
- Endocrinology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Sara Judith Galindo-Hernández
- Endocrinology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Raquel Socas Fernández del Castillo
- Centro de Salud de Las Dehesas, 38300 La Orotava, Tenerife, Spain
- Manuel Castilla-Marrero
- Centro de Salud Tejina, 38260 La Laguna, Tenerife, Spain
- Santiago Domínguez-Coello
- Centro de Salud de La Victoria de Acentejo, 38380, La Victoria de Acentejo, Tenerife, Spain
- Vanesa Vilchez de León
- Centro de Salud de Las Dehesas, 38300 La Orotava, Tenerife, Spain
- Rafael Valcárcel-Lopez
- Centro de Salud de Santa Ursula, 38390 Santa Ursula, Tenerife, Spain
- Nerea Insausti-Garmendia
- Centro de Salud La Cuesta, 38320 La Laguna, Tenerife, Spain
- Beatriz Escamilla
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Sara Estupiñán
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Patricia Delgado-Mallén
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Ana-María Armas-Padrón
- Centro de Salud La Cuesta, 38320 La Laguna, Tenerife, Spain
- Domingo Marrero-Miranda
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Ana González-Rinne
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Rosa María Miquel Rodríguez
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- María Angeles Cobo-Caso
- Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Laura Díaz-Martín
- Research Unit Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Federico González-Rinne
- Research Unit Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Alejandra González-Delgado
- Central Laboratory, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Marina López-Martínez
- Nephrology Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- Alejandro Jiménez-Sosa
- Research Unit Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
- Armando Torres
- Internal Medicine Department, ITB: Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38320 La Laguna, Tenerife, Spain
- Esteban Porrini
- Internal Medicine Department, ITB: Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38320 La Laguna, Tenerife, Spain
- DOI
- https://doi.org/10.3390/jcm8101543
- Journal volume & issue
-
Vol. 8,
no. 10
p. 1543
Abstract
Type 2 diabetes mellitus represents 30−50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtration rate in diabetic patients. We evaluated the error of creatinine and/or cystatin-C based formulas in reflecting real renal function over a wide range of glomerular filtration rate (from advanced chronic kidney disease to hyperfiltration). The error of estimated glomerular filtration rate by any equation was common and wide averaging 30% of real renal function, and larger in patients with measured glomerular filtration rate below 60 mL/min. This led to chronic kidney disease stages misclassification in about 30% of the individuals and failed to detect 25% of the cases with hyperfiltration. Cystatin-C based formulas did not outperform creatinine based equations, and the reliability of more modern algorithms proved to be as poor as older equations. Formulas failed in reflecting renal function in type 2 diabetes mellitus. Caution is needed with the use of these formulas in patients with diabetes, a population at high risk for kidney disease. Whenever possible, the use of a gold standard method to measure renal function is recommended.
Keywords
- type ii diabetes mellitus
- renal disease
- estimated glomerular filtration rate
- measured glomerular filtration rate
- plasma clearance of iohexol