Renal evaluation in patients with type 2 diabetes mellitus and its association with diastolic blood pressure
Background: HbA1c is correlated with the estimated glomerular filtration rate (eGFR) and diastolic blood pressure (DBP). Our main objective was to evaluate the trend of biochemical and clinical variables, in relation to the eGFR in patients with type 2 diabetes mellitus (T2DM).
Methods: This was a retrospective, longitudinal, and descriptive study, including patients with T2DM, who were cared for from January 2014 until December 2014, at the Clínica de Diabetes, Hospital Regional “Gral. Ignacio Zaragoza", ISSSTE, Mexico City, Mexico. eGFR was calculated using three formulas: the chronic kidney disease – epidemiology collaboration (CKD-EPI), Cockcroft-Gault, and modification of diet in renal disease (MDRD), during two periods of observation, 3 and 6 months. The results were compared by Student t tests or Wilcoxon-Mann-Whitney test depending on the variable distribution. Pearson correlation was employed to determine the relation between the eGFR determined with each formula and the analyzed variables.
Results: The mean age was 56.5±11.3 years in the group of 3 months’ follow-up (n=110) and 57.1±13.8 years in the group of 6 months’ follow-up (n=47). In both groups, the formula with the lowest percentages of cases of CKD was CKD-EPI and the difference of this formula had a basal and final significant positive correlation with the DBP.
Conclusion: The CKD-EPI formula showed the lowest percentages of cases of CKD in a short follow-up period, and its difference is consistently associated with the DBP, confirming the importance of controlling the later to mitigate the evolution to CKD.
Gigoux LJP, Moya Rivera P, Silva RJ. Adherencia al tratamiento farmacológico y relación con el control metabólico en pacientes con DM2. Rev Chil Salud Pública. 2010;14(2-3):238–70. Mexican.
Durán-Varela BR, Rivera-Chavira B, Franco-Gallegos E. [Pharmacological therapy compliance in diabetes]. Salud Publica Mex. 2001;43(3):233–6. http://dx.doi.org/10.1590/S0036-36342001000300009
Cruz HJ, Licea PME, Hernández GP, Abraham MEA, Yanes QM. Aldosa reductasa y proteína quinasa C en las complicaciones crónicas de la Diabetes Mellitus. Rev Latinoamer Patol Clin. 2011;58(2):102–7. Mexican.
Vejakama P, Ingsathit A, Attia J, Thakkinstian A. Epidemiological study of chronic kidney disease progression: a large-scale population-based cohort study. Medicine (Baltimore). 2015;94(4):e475. http://dx.doi.org/10.1097/MD.0000000000000475
Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, et al. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718–24. http://dx.doi.org/10.2215/CJN.02510213
Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. Clinical significance of nonalbuminuric renal impairment in type 2 diabetes. J Hypertens. 2011;29(9):1802–9. http://dx.doi.org/10.1097/HJH.0b013e3283495cd6
Earley A, Miskulin D, Lamb EJ, Levey AS, Uhliq K. Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med. 2012;156(11):785–95. http://dx.doi.org/10.7326/0003-4819-156-11-201203200-00391
Rigalleau V, Beauvieux MC, Gonzalez C, Raffaitin C, Lasseur C, Combe C, et al. Estimation of renal function in patients with diabetes. Diabetes Metab. 2011;37(5):359–66. http://dx.doi.org/10.1016/j.diabet.2011.05.002
Coresh J, Stevens LA. Kidney function estimating equations: where do we stand? Curr Opin Nephrol Hypertens. 2006;15(3):276–84. http://dx.doi.org/10.1097/01.mnh.0000222695.84464.61
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–54. http://dx.doi.org/10.7326/0003-4819-145-4-200608150-00004
Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M, et al. Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010;56(3):486–95. http://dx.doi.org/10.1053/j.ajkd.2010.03.026
Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Gómez-Sánchez L, Gómez-Sanchez M, et al. Cardio-ankle vascular index is associated with cardiovascular target organ damage and vascular structure and function in patients with diabetes or metabolic syndrome, LOD-DIABETES study: a case series report. Cardiovasc Diabetol. 2015;14:7. http://dx.doi.org/10.1186/s12933-014-0167-y
Uezima CB, Zanella MT, Sachs A, Pimazzoni Netto A, Zach PL. [Efect of short term glycemic control on microalbuminuria and glomerular filtration rate in type 2 diabetic patients with poor glycemic control]. J Bras Nefrol. 2012;34(2):130–8. http://dx.doi.org/10.1590/S0101-28002012000200005
Zanetti ML, Arrelias CC, Franco RC, Santos MA, Rodrigues FF, Faria HT. Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus. Rev Esc Enferm USP. 2015;49(4):619–25. http://dx.doi.org/10.1590/S0080-623420150000400012
Yu R, Yan LL, Wang H, Ke L, Yang Z, Gong E, et al. Effectiveness of a community-based individualized lifestyle intervention among older adults with diabetes and hypertension, Tianjin, China, 2008-2009. Prev Chronic Dis. 2014;11:120333. http://dx.doi.org/10.5888/pcd11.120333
Qi L, Feng L, Tang W, Ma X, Ding X, Mao D, et al. A community-based comprehensive intervention program for 7200 patients with type 2 diabetes mellitus in Chongqing (China). Int J Environ Res Public Health. 2014;11(11):11450–63. http://dx.doi.org/10.3390/ijerph111111450
Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins-Jones S, Rubin RR, et al. The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care. 2012;35(6):1279–84. http://dx.doi.org/10.2337/dc11-1277
Gutiérrez Herrera VR, Zerón HM, Mendieta Alcántara MR. Adherence to two methods of education and metabolic control in type 2 diabetics. Ethiop J Health Sci. 2015;25(2):163–70. http://dx.doi.org/10.4314/ejhs.v25i2.9
Ekinci EI, Jerums G, Skene A, Crammer P, Power D, Cheong KY, et al. Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013;36(11):3620–6. http://dx.doi.org/10.2337/dc12-2572
Liu F, Wu M, Feng YH, Zhong H, Cui T, Huang YQ, et al. Influence of HbA1c on short-term blood pressure variability in type 2 diabetic patients with diabetic nephropathy. J Zhejiang Univ Sci B. 2013;14(11):1033–40. http://dx.doi.org/10.1631/jzus.B1300030
Ibrahim H, Mondress M, Tello A, Fan Y, Koopmeiners J, Thomas W. An alternative formula to the Cockcroft-Gault and the modification of diet in renal diseases formulas in predicting GFR in individuals with type 1 diabetes. J Am Soc Nephrol. 2005;16(4):1051–60. http://dx.doi.org/10.1681/ASN.2004080692
Vervoort G, Willems HL, Wetzels JF. Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation. Nephrol Dial Transplant. 2002;17(11):1909–13. http://dx.doi.org/10.1093/ndt/17.11.1909
Pugliese G, Solini A, Bonora E, Orsi E, Zerbini G, Giorgino F, et al. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation provides a better definition of cardiovascular burden associated with CKD than the Modification of Diet in Renal Disease (MDRD) Study formula in subjects with type 2 diabetes. Atherosclerosis. 2011;218(1):194–9. http://dx.doi.org/10.1016/j.atherosclerosis.2011.04.035
Fabbian F, Pala M, Monesi M, De Giorgi A, Mallozzi Menegatti A, Tomasi F, et al. The estimation of glomerular filtration rate in type 2 diabetic patients may depend on the equation used. Eur Rev Med Pharmacol Sci. 2013;17(20):2791–7.
Chou CK, Weng SW, Chang HW, Chen CY, Su SC, Liu RT. Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan. Diabetes Res Clin Pract. 2008;81(3):331–7. http://dx.doi.org/10.1016/j.diabres.2008.04.027
Wakasugi M, Kazama JJ, Yamamoto S, Kawamura K, Narita I. A combination of healthy lifestyle factors is associated with a decreased incidence of chronic kidney disease: a population-based cohort study. Hypertens Res. 2013;36(4):328–33. http://dx.doi.org/10.1038/hr.2012.186
Jones-Burton C, Mishra SI, Fink JC, Brown J, Gossa W, Bakris GL, et al. An in-depth review of the evidence linking dietary salt intake and progression of chronic kidney disease. Am J Nephrol. 2006;26(3):268–75. http://dx.doi.org/10.1159/000093833
Nelson RG, Tuttle KR, Bilous RW, Gonzalez-Campoy JM, Mauer M, Molitch ME, et al. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis. 2012;60(5):850–86. http://dx.doi.org/10.1053/j.ajkd.2012.07.005
Navaneethan SD, Yehnert H, Moustarah F, Schreiber MJ, Schauer PR, Beddhu S. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565–74. http://dx.doi.org/10.2215/CJN.02250409
Penfornis A, Blicklé JF, Fiquet B, Quéré S, Dejager S. How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study. Vasc Health Risk Manag. 2014;10:341–52. http://dx.doi.org/10.2147/VHRM.S60312
Di Landro D, Catalano C, Lambertini D, Bordin V, Fabbian F, Naso A, et al. The effect of metabolic control on development and progression of diabetic nephropathy. Nephrol Dial Transplant. 1998;13(Suppl8):35–43. http://dx.doi.org/10.1093/ndt/13.suppl_8.35
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Fraser SD, Aitken G, Taal MW, Mindell JS, Moon G, Day J, et al. Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England. PloS One. 2015;10(2):e0118676. http://dx.doi.org/10.1371/journal.pone.0118676
Copyright (c) 2016 Fokine D. Anna, Mendieta Z. Hugo, Mendieta A.M. Ruth
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.