Prognostic Value of Insulin-Like Growth Factor-Binding Protein 7 in Patients with Heart Failure and Preserved Ejection Fraction

Background

The prognostic merit of insulin-like growth factor-binding protein 7 (IGFBP7) is unknown in heart failure and preserved ejection fraction (HFpEF).

Agreement between cystatin-C and creatinine based eGFR estimates after a 12-month exercise intervention in patients with chronic kidney disease

Background

Estimation of GFR (eGFR) using formulae based on serum creatinine concentrations are commonly used to assess kidney function. Physical exercise can increase creatinine turnover and lean mass; therefore, this method may not be suitable for use in exercising individuals. Cystatin-C based eGFR formulae may be a more accurate measure of kidney function when examining the impact of exercise on kidney function. The aim of this study was to assess the agreement of four creatinine and cystatin-C based estimates of GFR before and after a 12-month exercise intervention.

Methods

One hundred forty-two participants with stage 3–4 chronic kidney disease (CKD) (eGFR 25–60?mL/min/1.73?m²) were included. Subjects were randomised to either a Control group (standard nephrological care [n?=?68]) or a Lifestyle Intervention group (12?months of primarily aerobic based exercise training [n?=?74]). Four eGFR formulae were compared at baseline and after 12?months: 1) MDRDcr, 2) CKD-EPIcr, 3) CKD-EPIcys and 4) CKD-EPIcr-cys.

Results

Control participants were aged 63.5[9.4] years, 60.3% were male, 42.2% had diabetes, and had an eGFR of 40.5?±?8.9?ml/min/1.73m². Lifestyle Intervention participants were aged 60.5[14.2] years, 59.5% were male, 43.8% had diabetes, and had an eGFR of 38.9?±?8.5?ml/min/1.73m². There were no significant baseline differences between the two groups. Lean mass (r?=?0.319, p?<?0.01) and grip strength (r?=?0.391, p?<?0.001) were associated with serum creatinine at baseline. However, there were no significant correlations between cystatin-C and the same measures. The Lifestyle Intervention resulted in significant improvements in exercise capacity (+?1.9?±?1.8 METs, p?<?0.001). There were no changes in lean mass in both Control and Lifestyle Intervention groups during the 12?months. CKD-EPIcys was considerably lower in both groups at both baseline and 12?months than CKD-EPIcr (Control?=???10.5?±?9.1 and???13.1?±?11.8, and Lifestyle Intervention?=???7.9?±?8.6 and???8.4?±?12.3?ml/min/1.73?m²), CKD-EPIcr-cys (Control?=???3.6?±?3.7 and???4.5?±?4.5, and Lifestyle Intervention?=???3.6?±?3.7 and???2.5?±?5.5?ml/min/1.73?m²) and MDRDcr (Control?=???9.3?±?8.4 and???12.0?±?10.7, Lifestyle Intervention?=???6.4?±?8.4 and???6.9?±?11.2?ml/min/1.73?m²).

Conclusions

In CKD patients participating in a primarily aerobic based exercise training, without improvements in lean mass, cystatin-C and creatinine based eGFR provided similar estimates of kidney function at both baseline and after 12?months of exercise training.

Trial registration

The trial was registered at www.anzctr.org.au (Registration Number ANZCTR12608000337370) on the 17/07/2008 (retrospectively registered).

     

Chronic kidney disease categories and renal–cardiovascular outcomes in type 2 diabetes without prevalent cardiovascular disease: a prospective cohort study (JDDM25)

Aims/hypothesis

In type 2 diabetic patients at low risk for cardiovascular disease (CVD), the relationship between the clinical course of nephropathy by stage of chronic kidney disease (CKD) and onset of CVD remains unclear. Clarification of this relationship is important for clinical decision-making for both low- and high-risk diabetic patients.

Methods

This 4?year prospective study enrolled 2,954 type 2 diabetic patients with no prevalent CVD, and serum creatinine <176.8?μmol/l. The risk for CVD onset (non-fatal and fatal CVD and stroke, and peripheral arterial disease) was assessed according to CKD stage categorised by urinary albumin-to-creatinine ratio (ACR; mg/mmol) and estimated GFR (eGFR; ml?min^?1 1.73?m^?2). Association of progression from ‘no CKD’ stage (ACR <3.5?mg/mmol and eGFR ≥90?ml?min^?1 1.73?m^?2) with risk for CVD onset was also evaluated.

Results

During follow-up (median 3.8?years), 89 CVD events occurred. Compared with patients with ‘no CKD’ as reference, those with ACR?≥?35.0?mg/mmol with co-existing eGFR 60–89?ml?min^?1 1.73?m^?2 or <60?ml?min^?1 1.73?m^?2 showed increased risk for CVD onset, whereas those with eGFR ≥90?ml?min^?1 1.73?m^?2 did not. Those with ACR <3.5?mg/mmol and eGFR <60?ml?min^?1 1.73?m^?2 did not show any increased risk. Among patients with ‘no CKD’ stage at baseline, those who progressed to ACR ≥3.5?mg/mmol during follow-up showed an increased risk compared with those who did not, whereas those who progressed to eGFR <90?ml?min^?1 1.73?m^?2 did not have increased risk.

Conclusions/interpretation

The risk for CVD was associated with progression of albuminuria stage rather than eGFR stage in type 2 diabetic patients at relatively low risk for CVD.     

Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Aims/hypothesis

We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

Methods

Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5?years.

Results

Lower estimated GFR (eGFR) vs eGFR ??90?ml?min^?1 1.73?m^?2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01?C1.29] for eGFR 60?C89?ml?min^?1 1.73?m^?2; 1.59 [1.28?C1.98] for eGFR 30?C59?ml?min^?1 1.73?m^?2; p?<?0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01?C1.54] and 1.19 [0.76?C1.85], respectively; p?=?0.001 for trend) when eGFR ??90?ml?min^?1 1.73?m^?2. CVD risk was further modified by renal status changes over the first 2?years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure.

Conclusions/interpretation

Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.     

Risk factors for decline in renal function among young adults with type 1 diabetes

Aims

To investigate risk factors for declining renal function among subjects with type-1-diabetes.

Effects of bardoxolone methyl on body weight,waist circumference and glycemic control in obese patients with type 2 diabetes mellitus and stage 4 chronic kidney disease

Aims

Obesity is associated with progression of chronic kidney disease (CKD). Treatment with bardoxolone methyl in a multinational phase 3 trial, Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), resulted in increases in estimated glomerular filtration rate (eGFR) with concurrent reductions in body weight. We performed post-hoc analyses to further characterize reductions in body weight with bardoxolone methyl.

Central Chemoreceptor Sensitivity Is Not Enhanced in Contemporary Patients With Chronic Systolic Heart Failure Receiving Optimal Treatment

Background

Clinical and prognostic consequences of enhanced central chemosensitivity in the contemporary optimally treated patients with chronic heart failure (CHF) are unknown.

No survival benefit from early‐start dialysis in a population‐based,inception cohort study of Swedish patients with chronic kidney disease

Abstract. Evans M., Tettamanti G., Nyrén O., Bellocco R., Fored C.M., Elinder C.‐G. (Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; University of Milano‐Bicocca, Milan, Italy; Karolinska Institutet, Stockholm, Sweden) No survival benefit from early‐start dialysis in a population‐based, inception cohort study of Swedish patients with chronic kidney disease. J Intern Med 2010; 269 : 289–298. Objective. To investigate how the timing of dialysis initiation is associated with mortality. Design. Population‐based, prospective, observational cohort study. Setting. Clinical laboratories (n = 69) provided information on all patients in Sweden whose serum creatinine level for the first time and exceeded 3.4 mg dL^?1 (men) or 2.8 mg dL^?1 (women) between 20 May 1996 and 31 May 1998. Subjects. All patients (n = 901), aged 18–74 years, in whom the cause of serum creatinine elevation was chronic kidney disease, were included in the study; participants were interviewed and followed for 5–7 years. Main outcome measures. Information on date of death was obtained from a national Swedish population register. Early‐start dialysis [estimated glomerular filtration rate from serum creatinine (eGFR) ≥7.5 mL min^?1 per 1.73 m²] was compared to late start of dialysis (eGFR <7.5 mL min^?1 per 1.73 m²), and no dialysis. Relative risk [hazard ratio (HR)] of death was modelled with time‐dependent multivariate Cox proportional hazards regression. Results. Mean eGFR was 16.1 mL min^?1 per 1.73 m² at inclusion and 7.6 mL min^?1 per 1.73 m² at the start of dialysis. Among the 385 patients who started dialysis late, 36% died during follow‐up compared to 52% of 323 who started early. The adjusted HR for death was 0.84 [95% confidence interval (CI) 0.64, 1.10] among late versus early starters. The mortality among nondialysed patients increased significantly at eGFR below 7.5 mL min^?1 per 1.73 m² (HR 4.65; 95% CI 2.28, 9.49; compared to eGFR 7.5–10 mL min^?1 per 1.73 m²). After the start of dialysis, the mortality rate further increased. Compared to nondialysed patients with eGFR ≤15 mL min^?1 per 1.73 m², adjusted HR was 2.65 (95% CI 1.80, 3.89) for patients receiving dialysis. Conclusion. We found no survival benefit from early initiation of dialysis.     

Vasopressin-related copeptin is a novel predictor of early endothelial dysfunction in patients with adult polycystic kidney disease

Background

In this study, we examined the relative usefulness of serum copeptin levels as a surrogate marker of vasopressin (AVP) in adult polycystic kidney disease (ADPKD) by correlating it with baseline and longitudinal changes in markers of both renal function and common CVD manifestations (hypertensive vascular disease, atherosclerosis and endothelial dysfunction) that accompany the progression of this disease.

Methods

We studied a cohort of young and otherwise healthy ADPKD patients (n?=?235) and measured cardiovascular function using flow-mediation dilatation (FMD), carotid intima media thickness (cIMT) and pulse wave velocity (PWV), as well as serum copeptin (commercial ELISA, a stable marker of AVP activity). The same analyses were carried out at baseline and after 3 years of follow-up.

Results

At baseline, median eGFR was 69 mL/min./1.73 m², mean FMD 6.9?±?0.9%, cIMT 0.7?±?0.1 mm, and PWV 8.1?±?1.2 m/s. At follow-up, equivalent values were 65 (44–75) mL/min./1.73 m², 5.8?±?0.9%, 0.8?±?0.1 mm. and 8.2?±?1.3 m/s. with all changes statistically significant. Plasma copeptin also rose from 0.62?±?0.12 to 0.94?±?0.19 ng/mL and this change correlated with ΔeGFR (-0.33, p?<?0.001), ΔFMD (0.599, p?<?0.001), ΔcIMT (0.562, p?<?0.001) and ΔPWV (0.27, p?<?0.001) also after linear regression modeling to correct for confounders. Finally, ROC analysis was done for a high baseline copeptin with ΔeGFR [cut-off:≤59], ΔFMD [cut-off: ≤7.08], ΔcIMT [cut-off:>0.76], and ΔPWV [cut-off:≤7.80].

Conclusions

Vascular dysfunction as reflected by FMD and cIMT, but not PWV or an altered cardiac geometry, precede most other signs of disease in ADPKD but is predicted by elevated levels of the circulating AVP-marker copeptin.

     

Association between decreasing estimated glomerular filtration rate and risk of cardiac conduction defects in patients with type 2 diabetes

Aim

We aimed to assess the association between decreasing estimated glomerular filtration rate (eGFR) or abnormal albuminuria and the risk of certain cardiac conduction defects in patients with type 2 diabetes mellitus (T2DM).

Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study

Aims/hypothesis

Fenofibrate caused an acute, sustained plasma creatinine increase in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies. We assessed fenofibrate??s renal effects overall and in a FIELD washout sub-study.

Methods

Type 2 diabetic patients (n?=?9,795) aged 50 to 75?years were randomly assigned to fenofibrate (n?=?4,895) or placebo (n?=?4,900) for 5?years, after 6?weeks fenofibrate run-in. Albuminuria (urinary albumin/creatinine ratio measured at baseline, year?2 and close-out) and estimated GFR, measured four to six monthly according to the Modification of Diet in Renal Disease Study, were pre-specified endpoints. Plasma creatinine was re-measured 8?weeks after treatment cessation at close-out (washout sub-study, n?=?661). Analysis was by intention-to-treat.

Results

During fenofibrate run-in, plasma creatinine increased by 10.0???mol/l (p?p?=?0.01), with less estimated GFR loss (1.19 vs 2.03?ml min^?1 1.73?m^?2 annually, p??1 1.73?m^?2, p?=?0.065) than on placebo (6.9?ml min^?1 1.73?m^?2, p??1 1.73?m^?2 (95% CI 2.3?C7.7, p?n?=?169 vs 491 without) alone, or combined with low HDL-cholesterol (n?=?140 vs 520 without) and reductions of ??0.48?mmol/l in triacylglycerol over the active run-in period (pre-randomisation) (n?=?356 vs 303 without). Fenofibrate reduced urine albumin concentrations and hence albumin/creatinine ratio by 24% vs 11% (p?p?p?n?=?21 vs 26, p?=?0.48).

Conclusions/interpretation

Fenofibrate reduced albuminuria and slowed estimated GFR loss over 5?years, despite initially and reversibly increasing plasma creatinine. Fenofibrate may delay albuminuria and GFR impairment in type 2 diabetes patients. Confirmatory studies are merited.

Trial registration

ISRCTN64783481

Funding

The study was funded by grants from Laboratoires Fournier SA (Dijon, France; now part of Abbott Pharmaceuticals) and the National Health and Medical Research Council, Australia     

Comparison of the Effects of Telbivudine and Entecavir Treatment on Estimated Glomerular Filtration Rate in Patients with Chronic Hepatitis B

Background/Aims

The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis.

Methods

From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model.

Results

In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m²). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR <90 mL/min/1.73 m², the mean eGFR showed a steady improvement, whereas the mean eGFR was reduced in the same subgroups of ETV-treated patients.

Conclusions

The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment.     

In patients with type 1 diabetes simultaneous pancreas and kidney transplantation preserves long-term kidney graft ultrastructure and function better than transplantation of kidney alone

Aims/hypothesis

In patients with type 1 diabetes and end-stage renal disease (ESRD) we aimed to determine whether long-term normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, would preserve kidney graft structure and function better than live donor kidney (LDK) transplantation alone.

Methods

Estimated GFR (eGFR) was calculated in SPK (n?=?25) and LDK (n?=?17) recipients in a stable phase 3 months after transplantation and annually during follow-up. Kidney graft biopsies were obtained at follow-up for measurement of glomerular volume (light microscopy), glomerular basement membrane (GBM) and podocyte foot process widths and mesangial volume fraction (electron microscopy).

Results

SPK and LDK recipients were similar in age and diabetes duration at engraftment. Donor age was higher in the LDK group. Median follow-up time was 10.1 years. Mean HbA_1c levels during follow-up were 5.5?±?0.4% (37?±?5 mmol/mol) and 8.3?±?1.5% (68?±?16 mmol/mol) in the SPK and LDK group, respectively (p?p?=?0.008) and increased mesangial volume fraction (median 0.23 [range 0.13–0.59] vs 0.16 [0.10–0.41]; p?=?0.007) at follow-up. Absolute eGFR change from baseline was ?11?±?21 and ?23?±?15 ml min^?1 1.73 m^?2 (p?=?0.060), whereas eGFR slope was ?1.1 (95% CI ?1.7, ?0.5) and ?2.6 (95% CI ?3.1, ?2.1)?ml min^?1 1.73 m^?2 per year in the SPK and LDK group, respectively (p?=?0.001).

Conclusions/interpretation

In patients with type 1 diabetes and long-term normoglycaemia after successful SPK transplantation, kidney graft ultrastructure and function were better preserved compared with LDK transplantation alone.     

Vinorelbine-Cyclophosphamide compared to cyclophosphamide in peripheral blood stem cell mobilization for multiple myeloma

Background

High dose Cyclophosphamide (Cy) and Vinorelbine Cyclophosphamide (Vino-Cy) are stem cell (SC) mobilisation options for patients with multiple myeloma (MM). We present a comparison of mobilisation outcomes using these regimens.

MDRD or CKD-EPI study equations for estimating prevalence of stage 3 CKD in epidemiological studies: which difference? Is this difference relevant?

Background

Since men with chronic kidney disease (CKD) progress faster than women, an accurate assessment of CKD progression rates should be based on gender differences in age-related decline of glomerular filtration rate (GFR) in healthy individuals.

Methods

A Chinese sample population from a stratified, multistage, and clustered CKD screening study was classified into healthy, at-risk, and CKD groups. The gender differences in estimated GFR (eGFR) and age-related eGFR decline were calculated for each group after controlling for blood pressure, fasting glucose levels, serum lipids levels, education level, and smoking status. After referencing to the healthy group, gender-specific multivariate-adjusted rates of decline in eGFR and differences in the rates of decline were calculated for both CKD and at-risk groups.

Results

The healthy, at-risk, and CKD groups consisted of 4569, 7434, and 1573 people, respectively. In all the 3 groups, the multivariate-adjusted eGFRs in men were lower than the corresponding eGFRs in women. In addition, in the healthy and at-risk groups, the rates of decline in eGFR in men were lower than the corresponding rates of decline in women (healthy group: 0.51 mL·min^-1·1.73 m^-2·yr^-1 vs. 0.74 mL·min^-1·1.73 m^-2·yr^-1 and at-risk group: 0.60 mL·min^-1·1.73 m^-2·yr^-1 vs. 0.73 mL·min^-1·1.73 m^-2·yr^-1). However, in the CKD group, the rates of decline in eGFR in men were similar to those in women (0.96 mL·min^-1·1.73 m^-2·yr^-1 vs. 0.91 mL·min^-1·1.73 m^-2·yr^-1). However, after referencing to the healthy group, the rates of decline in eGFR in men in the at-risk and CKD groups were greater faster than the corresponding rates in women (at-risk group: 0.10 mL·min^-1·1.73 m^-2·yr^-1 vs. -0.03 mL·min^-1·1.73 m^-2·yr^-1 and CKD group: 0.44 mL·min^-1·1.73 m^-2·yr^-1 vs. 0.15 mL·min^-1·1.73 m^-2·yr^-1).

Conclusion

To accurately assess gender differences in CKD progression rates, gender differences in age-related decline in GFR should be considered.     

Non-albuminuric renal impairment is a strong predictor of mortality in individuals with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicentre study

Aims/hypothesis

Non-albuminuric renal impairment has become the prevailing diabetic kidney disease (DKD) phenotype in individuals with type 2 diabetes and an estimated GFR (eGFR) <60 ml min^?1 1.73 m^?2. In the present study, we compared the rate and determinants of all-cause death in individuals with this phenotype with those in individuals with albuminuric phenotypes.

Methods

This observational prospective cohort study enrolled 15,773 individuals with type 2 diabetes in 2006–2008. Based on baseline albuminuria and eGFR, individuals were classified as having: no DKD (Alb^?/eGFR^?), albuminuria alone (Alb⁺/eGFR^?), reduced eGFR alone (Alb^?/eGFR⁺), or both albuminuria and reduced eGFR (Alb⁺/eGFR⁺). Vital status on 31 October 2015 was retrieved for 15,656 individuals (99.26%).

Results

Mortality risk adjusted for confounders was lowest for Alb^?/eGFR^? (reference category) and highest for Alb⁺/eGFR⁺ (HR 2.08 [95% CI 1.88, 2.30]), with similar values for Alb⁺/eGFR^? (1.45 [1.33, 1.58]) and Alb^?/eGFR⁺ (1.58 [1.43, 1.75]). Similar results were obtained when individuals were stratified by sex, age (except in the lowest age category) and prior cardiovascular disease. In normoalbuminuric individuals with eGFR <45 ml min^?1 1.73 m^?2, especially with low albuminuria (10–29 mg/day), risk was higher than in microalbuminuric and similar to macroalbuminuric individuals with preserved eGFR. Using recursive partitioning and amalgamation analysis, prevalent cardiovascular disease and lower HDL-cholesterol were the most relevant correlates of mortality in all phenotypes. Higher albuminuria within the normoalbuminuric range was associated with death in non-albuminuric DKD, whereas the classic ‘microvascular signatures’, such as glycaemic exposure and retinopathy, were correlates of mortality only in individuals with albuminuric phenotypes.

Conclusions/interpretation

Non-albuminuric renal impairment is a strong predictor of mortality, thus supporting a major prognostic impact of renal dysfunction irrespective of albuminuria. Correlates of death partly differ from the albuminuric forms, indicating that non-albuminuric DKD is a distinct phenotype.

Trial registration:

ClinicalTrials.gov NCT00715481

     

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Background and objectives

Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function.

Design, setting, participants, & measurements

This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR<60 ml/min per 1.73 m²using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline (≥2.5 ml/min per 1.73 m² per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors.

Results

Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m². Incident eGFR<60 ml/min per 1.73 m² developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR<60 ml/min per 1.73 m² (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98).

Conclusions

A Mediterranean diet was associated with a reduced incidence of eGFR<60 ml/min per 1.73 m² and upper quartile of eGFR decline in a multiethnic cohort.     

Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia

Background

Diabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine.

Methods

A total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine.

Results

CKD, defined as eGFR?<?60 ml/min/1.73 m², was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR <60 ml/min/1.73 m² had abnormal serum creatinine values, i.e. > 1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2–3 CKD) despite normal creatinine levels. CKD, eGFR?<?60 ml/min/1.73 m², was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively.

Conclusion

CKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2–3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

     

Decreased eGFR as a Risk Factor for Heart Failure in 13 781 Individuals With Type 1 Diabetes

Background:

Impaired renal function is a well-known risk factor of cardiovascular disease, but its relation to heart failure in individuals with type 1 diabetes has been sparsely studied. The aim of our study was to quantify the risk increase for development of heart failure with decreasing kidney function in individuals with type 1 diabetes.

Methods:

Three equations were used to calculate eGFR (estimated glomerular filtration rate) for individuals with T1D and no known heart failure in the Swedish National Diabetes Registry. Proportional hazards regression models were constructed to evaluate the association between eGFR and hospitalization for heart failure (HF).

Results:

Among 13 781 individuals (mean age 41.1 [SD 13.3] years at baseline), 330 (2.4%) were hospitalized for HF over median follow-up of 7.0 years. Renal function was normal (eGFR > 90 mL/min/1.73 m²) in 67% of individuals according to the Cockcroft-Gault formula, compared to 51% and 41% according to the Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) formulas. For eGFR 45-60 ml/min/1.73 m², hazard ratios (HRs) for hospitalization (reference >90 mL/min/1.73 m²) were 3.18 (95% CI 2.17, 4.65), 2.12 (1.16, 3.08), and 2.44 (1.69, 3.55) using the Cockcroft-Gault, MDRD, and CKD-EPI formulas. With eGFR <30 ml/min/1.73 m² there was a HR of 3.78 (2.15, 5.91), 3.44 (2.14, 5.51), and 3.51 (2.21, 5.51) compared to normal kidney function (>90 mL/min/1.73 m²).

Conclusions:

In individuals with T1D, risk of hospitalization for heart failure was over 2 times greater at eGFR 45-60 ml/min/1.73 m² and more than 3 times greater at eGFR <30 ml/min/1.73 m² when compared to normal eGFR.