Estimated glomerular filtration rate in patients with type 2
                  <i>diabetes mellitus</i>

Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Ott, Joice Nedel; Uggeri, Douglas Prestes

doi:10.1590/1806-9282.60.06.010

Brasil

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ORIGINAL ARTICLES • Rev. Assoc. Med. Bras. 60 (6) • Nov-Dec 2014 • https://doi.org/10.1590/1806-9282.60.06.010 linkcopy

Estimated glomerular filtration rate in patients with type 2 diabetes mellitus

Estimativa da taxa de filtração glomerular em pacientes com diabetes mellitus tipo 2

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to estimate the glomerular filtration using the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, and serum creatinine in the screening of reduced renal function in patients with type two diabetes (T2DM) enrolled in the Family Health Strategy (ESF, Brazilian federal health-care program).

Methods: a cross-sectional descriptive and analytical study was conducted. The protocol consisted of sociodemographics, physical examination and biochemical tests. Renal function was analyzed through serum creatinine and glomerular filtration rate (GFR) estimated according to the CG, MDRD and CKD-EPI equations, available on the websites of the Brazilian Nephrology Society (SBN) and the (NKF).

Results: 146 patients aged 60.9±8.9 years were evaluated; 64.4% were women. The prevalence of serum creatinine >1.2 mg/dL was 18.5% and GFR <60 mL/min/1.73m² totaled 25.3, 36.3 and 34.2% when evaluated by the equations CG, MDRD and CKD-EPI, respectively. Diabetic patients with reduced renal function were older, had long-term T2DM diagnosis, higher systolic blood pressure and higher levels of fasting glucose, compared to diabetics with normal renal function. Creatinine showed strong negative correlation with the glomerular filtration rate estimated using CG, MDRD and CKD-EPI (-0.64, -0.87, -0.89) equations, respectively.

Conclusion: the prevalence of individuals with reduced renal function based on serum creatinine was lower, reinforcing the need to follow the recommendations of the SBN and the National Kidney Disease Education Program (NKDEP) in estimating the value of the glomerular filtration rate as a complement to the results of serum creatinine to better assess the renal function of patients.

type 2 diabetes mellitus; kidney function tests; kidney failure; chronic; public health

Variables	F (n=94)	M (n=52)	p
	M±DP	M±DP
Age (years)	59.7±9.2	63.3±8.1	0.04^* * : p<0.05; ^£ £ : Mann-Whitney test;
Body mass (Kg)	78.3+16.1	81.9±12.2	0.04^* * : p<0.05; ^£ £ : Mann-Whitney test;
Height (cm)	155.0±5.7	169.2±6.3	0.000^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;
BMI (Kg/m²)	32.5±6.3	28.7±4.1	0.000^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;
WC (cm)	105.8+14.5	103.8±10.2	0.18^£ £ : Mann-Whitney test;
HC (cm)	108.9+13.3	101.9±10.2	0.001^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;
TD-T2DM (years)	6.9±7.2	8.2±7.4	0.21^£ £ : Mann-Whitney test;
SBP (mmHg)	132.0±16.6	138.9±15.3	0.005^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;
DBP (mmHg)	82.7±10.8	82.5±14.8	0.45^£ £ : Mann-Whitney test;
Fasting blood glucose (mg/dL)	127.1±53.8	122.2±48.2	0.78^£ £ : Mann-Whitney test;
Total cholesterol (mg/dL)	179.6±44.1	169.9±52.2	0.23^? ? : Student's t test; kg: kilogram; cm: centimeters;
Triglycerides (mg/dL)	196.9±105.6	165.2±95.2	0.04^* * : p<0.05; ^£ £ : Mann-Whitney test;
Serum creatinine (mg/dL)	1.0±0.29	1.1±0.35	0.03^* * : p<0.05; ^£ £ : Mann-Whitney test;
CG (mL/min/1.73 m²)	80.6±32.0	85.7±30.5	0.16^£ £ : Mann-Whitney test;
MDRD (mL/min/1.73 m²)	66.2±22.1	79.3±26.4	0.001^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;
CKD-EPI (mL/min/1.73 m²)	66.5±20.4	74.5±20.5	0.01^ : p<0.01; F: female; M: male; M±DP: mean±standard deviation; ^£ £ : Mann-Whitney test;

Variables	Serum creatinine		CG		MDRD		CKD-EPI
	Normal (n=119)	Impaired (n=27)	Normal (n=109)	Impaired (n=37)	Normal (n=93)	Impaired (n=53)	Normal (n=96)	Impaired (n=50)
Gender (F¨M)	83¨36	11¨16	68¨41	26¨11	53¨40	41¨12^* * : p<0,05;	57¨39	37¨13
Age (years)	60.4±9.3	63.8±6.7^* * : p<0,05;	58.9±8.4	67.1±7.8^ : p<0,01;	59.9±9.3	62.9±8.1^* * : p<0,05;	59.2±9.4	64.4±6.9^ : p<0,01;
TD-T2DM (years)	6.8±6.7	9.8±9.1	6.7±6.5	9.6±8.5^* * : p<0,05;	6.4±6.1	9.0±8.7^* * : p<0,05;	6.4±6.0	9.2±9.0
BMI (Kg/m²)	31.3±6.0	30.3±5.0	32.3±5.7	27.7±4.8^ : p<0,01;	30.6±5.3	32.0±6.8	30.7±5.5	32.0±6.4
WC (cm)	104.8±13.3	106.4±12.7	107.5±11.8	98.1±14.3^ : p<0,01;	104.5±10.9	106.3±16.3	104.3±11.7	106.7±15.5
HC (cm)	106.8±13.2	104.9±10.2	108.8±12.0	99.2±12.2^ : p<0,01;	105.9±12.7	107.3±12.8	105.8±13.2	107.6±11.7
SBP (mmHg)	132.7±15.2	142.2±19.5^* * : p<0,05;	134.1±16.3	135.6±17.3	133.0±16.1	137.0±17.1	132.6±15.9	138.0±17.0^* * : p<0,05;
DBP (mmHg)	81.7±11.2	86.7±15.9	82.8±12.8	82.4±10.7	82.1±13.0	83.7±11.1	81.9±12.8	84.1±11.2
TC (mg/dL)	175.6±45.5	178.4±55.1	178.7±47.1	168.7±47.3	178.1±45.7	172.8±49.9	178.3±46.6	172.1±48.5
Trig. (mg/dL)	186.2±104.9	183.0±94.4	188.1±98.3	178.2±116.1	182.8±95.7	190.5±115.0	185.1±105.5	186.5±98.4
FG (mg/dL)	120.0±45.0	148.7±71.3	124.9±48.3	126.4±61.6	121.2±43.8	132.5±63.3	123.7±46.5	128.5±61.1

	GFR CG	GFR MDRD	GFR CKD-EPI
	r	r	r
Age (years)	-0.57^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	-0.20^* * : p=0.05;	-0.30^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.
TD-T2DM (years)	-0.29^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	-0.18^* * : p=0.05;	-0.21^ : p<0.01;
Body mass (Kg)	0.44^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	0.16	-0.02
Body mass index (kg/m²)	0.38^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	-0.07	-0.08
Fasting blood glucose (mg/dL)	0.07	-0.04	-0.02
Total cholesterol (mg/dL)	-0.01	-0.02	-0.00
Triglycerides (mg/dL)	-0.05	-0.14	-0.11
Serum creatinine (mg/dL)	-0.64^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	-0.87^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.	-0.89^* ***** : p<0.001; ; CG: Cockcroft-Gault; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; TD-T2DM: Time of diagnosis of T2DM; BMI: body mass index; Kg/m2: kilograms per square meter;WC: waist circumference; cm: centimeters; HC: hip circumference; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; TC: total cholesterol; mg: milligrams; dL: deciliter; Trig.: triglycerides; FG: fasting blood glucose.

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[TFN01] ^*
: p<0.05;

[TFN02] ^**
: p<0.01; F: female; M: male; M±DP: mean±standard deviation;

[TFN03] ^£
: Mann-Whitney test;

[TFN04] ^?
: Student's t test; kg: kilogram; cm: centimeters;

[5] Kg/m²: kilograms per square meter; WC: waist circumference; HC: hip circumference; TD-T2DM: time of diagnosis of T2DM; SBP: systolic blood pressure; mmHg: millimeters of mercury; DBP: diastolic blood pressure; mg: milligrams; dL: deciliter; CG: Cockcroft-Gault; mL: milliliter; min: minute; m²: square meter; MDRD: Modification of Diet in Renal Disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration.