title: The GFR and GFR decline cannot be accurately estimated in type 2 diabetics.
abstract: There are no adequate studies that have formally tested the performance of different estimating formulas in patients with type 2 diabetes both with and without overt nephropathy. Here we evaluated the agreement between baseline GFRs, GFR changes at month 6, and long-term GFR decline measured by iohexol plasma clearance or estimated by 15 creatinine-based formulas in 600 type 2 diabetics followed for a median of 4.0 years. Ninety patients were hyperfiltering. The number of those identified by estimation formulas ranged from 0 to 24:58 were not identified by any formula. Baseline GFR was significantly underestimated and a 6-month GFR reduction was missed in hyperfiltering patients. Long-term GFR decline was also underestimated by all formulas in the whole study group and in hyper-, normo-, and hypofiltering patients considered separately. Five formulas generated positive slopes in hyperfiltering patients. Baseline concordance correlation coefficients and total deviation indexes ranged from 32.1% to 92.6% and from 0.21 to 0.53, respectively. Concordance correlation coefficients between estimated and measured long-term GFR decline ranged from -0.21 to 0.35. The agreement between estimated and measured values was also poor within each subgroup considered separately. Thus, our study questions the use of any estimation formula to identify hyperfiltering patients and monitor renal disease progression and response to treatment in type 2 diabetics without overt nephropathy.
authors: Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
authors: Flavio
authors: F
authors: Gaspari
authors: Piero
authors: P
authors: Ruggenenti
authors: Esteban
authors: E
authors: Porrini
authors: Nicola
authors: N
authors: Motterlini
authors: Antonio
authors: A
authors: Cannata
authors: Fabiola
authors: F
authors: Carrara
authors: Alejandro
authors: A
authors: Jiménez Sosa
authors: Claudia
authors: C
authors: Cella
authors: Silvia
authors: S
authors: Ferrari
authors: Nadia
authors: N
authors: Stucchi
authors: Aneliya
authors: A
authors: Parvanova
authors: Ilian
authors: I
authors: Iliev
authors: Roberto
authors: R
authors: Trevisan
authors: Antonio
authors: A
authors: Bossi
authors: Jelka
authors: J
authors: Zaletel
authors: Giuseppe
authors: G
authors: Remuzzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol; D007558:Italy; D007668:Kidney / Q000503:physiopathology*; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D017524:Slovenia; D013997:Time Factors
chemical_list: D015415:Biomarkers; D007472:Iohexol; D003404:Creatinine