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The Error of Estimated GFR in Type 2 Diabetes Mellitus

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Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, 28040 Madrid, Spain
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Centro de Salud Tejina, 38260 La Laguna, Tenerife, Spain
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Endocrinology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
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Centro de Salud de Puerto de la Cruz- Casco Botánico, 38400 Puerto de la Cruz, Tenerife, Spain
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Centro de Salud de La Vera, 38400 Puerto de la Cruz, Tenerife, Spain
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Research Unit Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
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Centro de Salud de Las Dehesas, 38300 La Orotava, Tenerife, Spain
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Centro de Salud de La Victoria de Acentejo, 38380, La Victoria de Acentejo, Tenerife, Spain
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Centro de Salud de Santa Ursula, 38390 Santa Ursula, Tenerife, Spain
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Centro de Salud La Cuesta, 38320 La Laguna, Tenerife, Spain
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Nephrology Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
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Central Laboratory, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain
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Nephrology Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
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Internal Medicine Department, ITB: Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38320 La Laguna, Tenerife, Spain
*
Author to whom correspondence should be addressed.
Unidad de Ensayos Clínicos-UCICEC. University Hospital of the Canary Islands, Ofra s/n La Cuesta, 38320 La Laguna, S/C Tenerife, Spain.
J. Clin. Med. 2019, 8(10), 1543; https://doi.org/10.3390/jcm8101543
Received: 19 August 2019 / Revised: 17 September 2019 / Accepted: 18 September 2019 / Published: 26 September 2019
(This article belongs to the Special Issue Diabetic Nephropathy: Diagnosis, Prevention and Treatment)
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. View Full-Text
Keywords: Type II diabetes mellitus; renal disease; estimated glomerular filtration rate; measured glomerular filtration rate; plasma clearance of iohexol Type II diabetes mellitus; renal disease; estimated glomerular filtration rate; measured glomerular filtration rate; plasma clearance of iohexol
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Luis-Lima, S.; Higueras Linares, T.; Henríquez-Gómez, L.; Alonso-Pescoso, R.; Jimenez, A.; López-Hijazo, A.M.; Negrín-Mena, N.; Martín, C.; Sánchez-Gallego, M.; Galindo-Hernández, S.J.; Socas Fernández del Castillo, R.; Castilla-Marrero, M.; Domínguez-Coello, S.; Vilchez de León, V.; Valcárcel-Lopez, R.; Insausti-Garmendia, N.; Escamilla, B.; Estupiñán, S.; Delgado-Mallén, P.; Armas-Padrón, A.-M.; Marrero-Miranda, D.; González-Rinne, A.; Miquel Rodríguez, R.M.; Cobo-Caso, M.A.; Díaz-Martín, L.; González-Rinne, F.; González-Delgado, A.; López-Martínez, M.; Jiménez-Sosa, A.; Torres, A.; Porrini, E. The Error of Estimated GFR in Type 2 Diabetes Mellitus. J. Clin. Med. 2019, 8, 1543.

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