Comparación de las ecuaciones MDRD y de las antiguas ecuaciones CKD-EPI frente a las nuevas ecuaciones CKD-EPI en pacientes con trasplante renal cuando se emplea 51Cr-EDTA para medir el filtrado glomerular

BackgroundWhen estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques.ObjectiveTo analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against ⁵¹Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year.ResultsThe mean measured GFR was 43.0 ± 11.4 (18.2–79.4) ml/min/1.73 m², with creatinine levels of 1.42 ± 0.46 (0.60-4.33) mg/dl and cystatin C levels of 1.45 ± 0.53 (0.42-3.48) mg/l. This correlated moderately with creatinine (r = –0.61, P< .001) and cystatin C (r = –0.52, P< .001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1 ml/min/1.73 m² for MDRD, +16.4 ml/min/1.73 m² for 2009-CKD-EPI, +15 ml/min/1.73 m² for CKD-EPI with cystatin C, and +14.1 ml/min/1.73 m² for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with ⁵¹Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60 ml/min/1.73 m².ConclusionsThe 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.     

Medición y estimación del filtrado glomerular posdonación renal

BackgroundLong-term consequences associated with kidney donation are controversial. Pre- and post-donation glomerular filtration rates (GFRs) are determinants of renal and cardiovascular risk weighting. In Latin America, there is limited experience in evaluating kidney function using GFR measurement techniques in kidney donors. The MDRD 4-variable and CKD-EPI equations are considered reasonable options. The objective of this study was to evaluate the performance of the MDRD and CKD-EPI equations in post-nephrectomy GFR dynamics in kidney donors.Materials and methodsA prospective cohort study with GFR measurement and estimation in 189 kidney donors who underwent nephrectomy between 2007 and 2016 at the Hospital Privado Universitario de Córdoba [Private University Hospital of Córdoba] in Córdoba, Argentina. GFRs were evaluated before and after nephrectomy by iothalamate clearance determined by HPLC and by the MDRD and CKD-EPI equations for estimating GFR. Two groups were formed for this study: Group 1 (n = 107), with an evaluation time subsequent to GFR stabilization (3 months) of up to 5 years, and Group 2 (n = 82), with an evaluation time of 5-10 years following donation. Measured GFR (mGFR) was assessed by iothalamate clearance determined by HPLC.ResultsRenal compensation values were 61.9% (52.0%-71.1%) and 75.6% (64.9%-84.4%) for Group 1 (n = 107) and Group 2 (n = 82), respectively. MDRD underestimated the GFR in 3.2% (90 ml/min/1.73m²) and 38.6% (60 ml/min/1.73m²) compared to the mGFR, and CKD-EPI underestimated the GFR in 2.6% (90 ml/min/1.73 m²) and 13.8% (60 ml/min/1.73 m²). Diagnostic performance was evaluated with a ROC curve (mGFR < 60 ml/min/1.73 m²) for MDRD (ABC = 0.66; CI: 0.59-0.73; sensitivity: 98.7%; specificity: 63.3%) and for CKD-EPI (ABC = 0.79 CI: 0.73-0.85; sensitivity: 96.9%; specificity: 76.4%. Estimated GFR (eGFR) showed poor performance for estimating the glomerular filtration rate in the post-nephrectomy follow-up of donors over 50 years of age.ConclusionsEquations for estimating GFRs showed poor performance for long-term follow-up of post-nephrectomy GFRs. Measuring GFRs to determine kidney function is recommended in the screening and follow-up of some donors under the current selection criteria.     

Association of single measurement of estimated glomerular filtration rate and non-quantitative dipstick proteinuria with all-cause and cardiovascular mortality in the elderly. Results from the Progetto Veneto Anziani (Pro.V.A.) Study

ObjectiveTo explore the independent and combined clinical validity of estimated glomerular filtration rate (eGFR) and proteinuria on predicting all-cause and cardiovascular mortality in an Italian elderly population.MethodsBaseline eGFR and proteinuria, all-cause and cardiovascular mortality during a mean follow-up time of 4.4 years were evaluated in 3063 subjects aged 65 years and older of the Progetto Veneto Anziani (Pro.V.A.) Study.ResultsSubjects with eGFR < 60 ml/min/1.73 m² (n = 956) presented a higher prevalence of proteinuria in comparison with those with eGFR ≥ 60 ml/min/1.73 m² (33.8% vs 25.1%, p < 0.01). After multivariable adjustment including proteinuria and major diseases, eGFR < 60 ml/min/1.73 m² was not associated with increased all-cause mortality. After multivariable adjustment including eGFR and major diseases, proteinuria was associated with all-cause mortality in overall subjects (HR = 1.43, 95% CI 1.15–1.78, p < 0.01), and in both sexes. After multivariable adjustment both eGFR < 60 ml/min/1.73 m² (HR = 1.68, 95% CI 1.02–2.78, p = 0.04), and proteinuria (HR = 2.07, 95% CI 1.31–3.27, p < 0.01) were associated with increased cardiovascular mortality. Subjects with both impaired eGFR and presence of proteinuria showed a higher risk for both all-cause and cardiovascular mortality compared to those with normal eGFR and absence of proteinuria.ConclusionIn this general Italian elderly population proteinuria is an independent predictor of all-cause and cardiovascular mortality, while eGFR is not an independent predictor of all-cause mortality, and it is nominally significantly associated with cardiovascular mortality. However, mortality risk is higher in individuals with combined reduced eGFR and proteinuria.     

Geriatric assessment and chronic kidney disease in the oldest old: The Octabaix study

BackgroundThe prevalence of chronic kidney disease (CKD) in older people is increasing.We determine the proportion of CKD in a sample of 321, 85-year-old community-dwelling subjects, and assess the association of socio-demographic data, global geriatric assessment data and comorbidity with CKD according to the estimated glomerular filtration rate (eGFR) of subjects.MethodsSerum creatinine, eGFR (derived in ml/min/1.73 m² using the Modification of Diet in Renal Disease formula), socio-demographic variables, the Barthel Index (BI), the Spanish version of the Mini-Mental State Examination (MEC), the Mini Nutritional Assessment (MNA), the Charlson Index, the Gait Rating Scale, social risk, quality of life and prevalent chronic diseases were collected.ResultsCKD prevalence was 56.7% for eGFR < 60 ml/min/1.73 m², 19.9% for eGFR < 45 ml/min/1.73 m² and 6.6% for GFR < 30 ml/min/1.73 m². Multiple logistic regression analysis showed that a prior diagnosis of hypertension was associated with an eGFR < 60 ml/min/1.73 m² (p < 0.008, OR 2.134, 95% CI 1.216–3.744). A diagnosis of heart failure (p < 0.001, OR 3.610, 95% CI 1.677–7.771) and a poor score on the quality of life measure (p < 0.008, OR 0.9660, 95% CI 0.966–0.995) were associated with an eGFR < 45 ml/min/1.73 m².ConclusionsMore than half of the oldest old in this study had an eGFR < 60 ml/min/1.73 m². A history of hypertension was associated with CKD. The group of patients with an eGFR < 45 ml/min/1.73 m² was associated with a diagnosis of heart failure and a worse quality of life.     

Taxa de filtração glomerular: que fórmula deverá ser usada em doentes com enfarte agudo do miocárdio?

IntroductionThere is disagreement regarding the best method for assessing renal dysfunction in patients with myocardial infarction (MI). This study aims to compare two commonly used formulas for measuring glomerular filtration rate (GFR) (Cockcroft-Gault [CG] and modification of diet in renal disease [MDRD]) in terms of predicting extent of coronary artery disease (CAD) and short- and long-term cardiovascular risk.MethodsWe studied 452 patients admitted to a cardiac intensive care unit (ICU) with MI (age 69.01 ± 13.64 years; 61.7% male, 38.5% diabetic) and followed for two years. CG and MDRD GFR estimates were compared in terms of prediction of CAD extent, in-hospital mortality risk and cardiovascular risk during follow-up.ResultsGFR <60 ml/min/1.73 m² using the MDRD formula was associated with a tendency for more extensive CAD (2.70 affected segments vs. 2.20, p = 0.052) and higher two-year mortality risk (p < 0.001, OR 3.84, 95% CI 2.04-7.22) and risk for reinfarction (p < 0.001, OR 4.09, 95% CI 2.00-8.39), decompensated heart failure (DHF) (p < 0.001, OR 3.95, 95% CI 2.04-7.66) and combined cardiovascular endpoints (p = 0.001, OR 2.47, 95% CI 1.47-4.17). Using the CG formula, GFR < 60 ml/min/1.73 m² only predicted higher risk for DHF (p = 0.016, OR 4.5, 95% CI 1.11-16.57), despite a tendency for more overall combined cardiovascular endpoints (p = 0.09, OR 2.84). Both formulas predicted in-hospital mortality.Discussion/ConclusionsThis study confirmed the value of GFR in predicting various cardiovascular endpoints in patients with MI. Compared to the CG formula, the MDRD formula was significantly more accurate in predicting the severity of CAD and two-year CV risk in patients admitted to the ICU with MI.     

Comparative performance of FAS equation and Asian modified CKD-EPI in the determination of GFR in Chinese patients with CKD with the 99mTc-DTPA plasma clearance as the reference method

BackgroundGlomerular filtration rate (GFR) is a useful index in many clinical conditions. However, very few studies have assessed the performance of full age spectrum (FAS) equation and the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation in the approximation of GFR in Chinese patients with chronic kidney disease.ObjectiveThis study aimed to compare the diagnostic performance of the above two creatinine-based equations.MethodsA well designed single-center cross-sectional study was performed and the GFR was determined by 3 methods separately in the same day: technetium-99m-diethylene triamine pentaacetic acid (^99mTc-DTPA) dual plasma sample clearance method (mGFR); FAS equation method; Asian modified CKD-EPI equation method. The gold standard method was the mGFR. Equations performance criteria considered correlation coefficient, bias, precision, accuracy and the ability to detect the mGFR less than 60 ml/min/1.73 m².ResultsA total of 160 patients were enrolled. The diagnostic performance of FAS showed no significant difference in the correlation coefficient (0.89 vs 0.89), precision (15.9 vs 16.1 ml/min/1.73 m²), accuracy (75.0% vs 76.3%) and the ability to detect the mGFR less than 60 ml/min/1.73 m² (0.94 vs 0.94) compared with the Asian modified CKD-EPI equation in all participants. The FAS showed a negative bias, while the new CKD-EPI equation showed a positive bias (?1.20 vs 1.30 ml/min/1.73 m², P < 0.001). However, they were all near to zero. In the mGFR < 60 ml/min/1.73 m² subgroup and mGFR > 60 ml/min/1.73 m² subgroup were consistent with that in the whole cohort. The precision and accuracy decreased when GFR > 60 ml/min/1.73 m² in both equations.ConclusionsThe FAS equation and the Asian modified CKD-EPI equation had similar performance in determining the glomerular filtration rate in the Chinese patients with chronic kidney disease. Both the FAS equation and Asian modified CKD-EPI can be a satisfactory method and may be the most suitable creatinine-based equation.     

Fórmula de CKD‐EPI versus Cockcroft‐Gault na predição de nefropatia induzida por contraste após intervenção coronária percutânea,em pacientes sem disfunção renal significativa

Introduction

Individuals with glomerular filtration rate (GFR) ≥ 60 ml/min/1.73 m² estimated by the Cockcroft‐Gault formula (CG) who undergo percutaneous coronary intervention (PCI) frequently develop contrast‐induced nephropathy (CIN). This study aimed to assess whether individuals with significant renal impairment assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) formula, but not by CG, more often develop CIN following PCI than those without renal impairment by either formula.

eGFR and creatinine clearance in relation to metabolic changes in an unselected patient population

BackgroundIt is widely assumed that moderate to severe renal failure (creatinine clearance < 60 ml/min; or an MDRD-4 (Modification of Diet in Renal Disease equation) < 60 ml/min/1.73 m²) is associated with metabolic changes, often needing further assessment and treatment. We investigated whether such abnormalities are already present at earlier stages of kidney disease, as assessed by 24-hour urine sampling and MDRD-4 calculation.MethodsA select, retrospective cohort study was conducted. Creatinine clearance was measured by collecting 24-hour urines. The individual eGFRs were calculated with the MDRD-4 formula and patients were then divided by renal function category (< 15, 15–30, 30–45, 45–60, 60–90, > 90 ml/min(/1.73 m²)). Per clearance category the number of people with anaemia, hypokalaemia, uraemia and hyperphosphataemia was evaluated.ResultsThe median creatinine clearance rate was 67.3 ml/min (quartiles: 42.9–95.8) versus a median MDRD-4-eGFR of 51.6 ml/min/1.73 m² (35.8–67.7). Anaemia, hyperkalaemia, hypocalcaemia, and uraemia were found to be present at higher levels of creatinine clearance rate and eGFR than previously reported (p < 0.0005). This increased prevalence was more pronounced in elderly subjects, particularly with respect to anaemia (OR 2.71 and 2.02 for MDRD-4 and creatinine clearance respectively, p < 0.0005). The same holds for the proportion with uraemia (OR 1.85, p < 0.0005) and hypocalcaemia (OR 1.97, p = 0.011) for MDRD-4.ConclusionMetabolic changes in an in- and outpatient hospital population are present at earlier stages than was stated in recent guidelines, especially when creatinine clearance levels are used as indicators. This might have implications for testing and treatment of patients with suspected kidney disease and/or loss of renal function.     

Type 1 diabetes in Cheshire: cardiometabolic risk factor trends (2004-2009)

AimsIn the context of changes in the last 10 years in treatment strategies for type 1 diabetes we evaluated longitudinal trends in cardiometabolic risk factor profiles in a population from North-West England.MethodsWe retrospectively examined longitudinal case records for the period for 291 adult patients followed up between 2004 and 2009 (age range 16–85). Data search was performed through the EMIS^® software provider using data held in primary care.ResultsLongitudinal analysis of individually followed patients indicated a mean 0.4% reduction in HbA1c from 8.3% (67 mmol/mol) at baseline (p = 0.002). The proportion of patients with an HbA1c ≥10% (86 mmol/mol) at baseline had a significant reduction over time from 14.0% to 9.5% (χ² = 9.4, p = 0.002). BMI remained unchanged (28.3 vs 28.4 kg/m²). However total cholesterol fell by 12.5% from 4.8 mM to 4.2 mM, (p < 0.0001) with a corresponding 23% reduction in LDL-cholesterol from 3.0 mm to 2.3 mM (p < 0.0001). There was a significant fall in diastolic BP (78–74 mmHg, p = 0.0016). In a mixed longitudinal regression model, HbA1c was associated with LDL-C (β = 0.28, p < 0.001) and age (β = 0.02, p = 0.001), independent of BMI, gender and systolic BP.DiscussionIn spite of intensive work to improve glycaemic control in type 1 diabetes, mean HbA1c remains above target for many people in our area, highlighting the difficulty of achieving glycaemic targets in type 1 diabetes. The significant reduction in diastolic BP, LDL and total cholesterol may have long-term benefit in cardiovascular event rate reduction.     

Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification

AimsData on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status.MethodsIn the U.S. National Health and Nutrition Examination Surveys 2003–2006, we examined in 10,637 adults aged ≥ 30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status.Results6.6% (n = 889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c < 7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p < 0.0001). Overall, 44.2% were at a BP goal of < 130/80 mmHg, 43.8% had an LDL-C < 100 mg/dl (2.6 mmol/L), and 13.9% a BMI < 25 kg/m². Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin).ConclusionsU.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.     

Acute caloric restriction improves glomerular filtration rate in patients with morbid obesity and type 2 diabetes

AimThe role of caloric restriction in the improvement of renal function following bariatric surgery is still unclear; with some evidence showing that calorie restriction can reduce proteinuria. However, data on the impact of caloric restriction on renal function are still lacking.MethodsRenal function, as measured by glomerular filtration rate (GFR), was evaluated in 14 patients with type 2 diabetes mellitus, morbid obesity and stage 2 chronic kidney disease before and after a 7-day very low-calory diet (VLCD).ResultsAfter the VLCD, both GFR and overall glucose disposal (M value) significantly increased from 72.6 ± 3.8 mL/min/1.73 m⁻² BSA to 86.9 ± 6.1 mL/min/1.73 m⁻² BSA (P = 0.026) and from 979 ± 107 μmol/min¹/m² BSA to 1205 ± 94 μmol/min¹/m² BSA (P = 0.008), respectively. A significant correlation was observed between the increase in GFR and the rise in M value (r = 0.625, P = 0.017).ConclusionOur observation of improved renal function following acute caloric restriction before weight loss became relevant suggesting that calory restriction per se is able to affect renal function.     

Factors influencing renal function after liver transplantation. Results from the MOST,an international observational study

IntroductionRenal failure, both acute and chronic, is a common complication after liver transplantation and can seriously jeopardise long-term outcome. Given organ shortage it should be essential to determine which patients will experience progressive and severe renal dysfunction after liver transplantation (LT).AimTo correlate pre-transplant renal function and risk factors for renal failure after liver transplantation with occurrence of renal failure at 1 and 5 years after LT, with particular attention to hepatitis C virus (HCV) infection.MethodsData from patients enrolled in the liver section of Neoral^® MOST (Multinational Observational Study in Transplantation) study were used for the analysis. HCV status, pre-transplant serum creatinine level, recipient gender, recipient age, pre-transplant arterial hypertension, pre-transplant diabetes mellitus, pre-transplant antiviral therapy, the time of the transplant (before or after 2000) and immunosuppressive regimen were collected for each patient. Post-transplant occurrence of renal failure at 1 and 5 years was defined as a GFR < 60 mL/min/1.73 m² (Stage III of the National Kidney Foundation).ResultsData from 1948 patients enrolled in the study were considered. Glomerular filtration rate (GFR) was evaluated in 406 patients at 1 year and in 233 patients at 5 years after LT. The prevalence of HCV infection was 35% in the former and 37% in the latter. The median GFR was 70 mL/min/1.73 m² after 1 year and 69 mL/min after 5 years, significantly lower in HCV-positive (HCV+) than in HCV-negative (HCV−) patients both 1 and 5 years after LT (p < 0.001). GFR before transplant correlated with GFR at 1 month, 1 and 3 years (p < 0.0001 for all correlations). Multivariate analysis confirmed HCV status, pre-LT serum creatinine levels and recipient gender as significant predictors of 1-year GFR (p < 0.001 for all three). Further analysis of the effect of recipient gender indicated that the only significant risk factor observed in both male and female patients was HCV positivity. Only 1-year GFR was an independent predictor of 5-year GFR (p < 0.001). HCV+ status, cyclosporine (CsA) exposure, antiviral therapy and diabetes mellitus had no significant influence on 5-year GFR.ConclusionsHCV status and pre-LT serum creatinine levels were independent predictors of renal function a year after LT, together with GFR before transplant. The negative impact of HCV positivity on renal function was not confirmed in the long term, whereas the prognostic influence of an abnormal renal function in the early post-transplant period was more persistent.     

Pancreatic β-cell function relates positively to HDL functionality in well-controlled type 2 diabetes mellitus

BackgroundHigh density lipoproteins (HDLs) have been implicated in glucose homeostasis. Among subjects with normal fasting glucose (NFG), impaired fasting glucose (IFG) and Type 2 diabetes mellitus (T2DM) we tested whether pancreatic β-cell function relates to HDL functionality, as determined by HDL anti-oxidative capacity and cellular cholesterol efflux to plasma.Subjects and methodsHDL anti-oxidative capacity (inhibition of LDL oxidation in vitro), cellular cholesterol efflux (the ability of plasma to stimulate cholesterol efflux out of cultured fibroblasts obtained from a single human donor), glucose and insulin were determined in fasting plasma samples from 37 subjects with NFG, 36 with IFG and 22 with T2DM (no glucose lowering drug or insulin treatment; HbA1c 6.0 ± 1.0%). Homeostasis model assessment was used to estimate pancreatic β-cell function (HOMA-β) and insulin resistance (HOMAir).ResultsHOMA-β was lowest, whereas HOMAir was highest in T2DM (P < 0.01 and P < 0.001 vs. NFG). HDL anti-oxidative capacity and cellular cholesterol efflux did not differ significantly according to glucose tolerance category. In univariate analysis and after controlling for HOMAir both HDL anti-oxidative capacity (P < 0.05) and cellular cholesterol efflux (P < 0.01) were positively correlated with HOMA-β in T2DM, but not in NFG and IFG. In age-, sex- and HOMAir-adjusted analyses, T2DM status interacted positively with HDL anti-oxidative capacity (P = 0.001) and cellular cholesterol efflux (P = 0.042) on HOMA-β. HbA1c interacted similarly with HDL functionality measures on HOMA-β.ConclusionsPancreatic β-cell function relates to pathophysiologically relevant measures of HDL function in T2DM, but not in NFG and IFG. Better HDL functionality may contribute to maintenance of β-cell function in subjects with well-controlled T2DM.     

Metabolic syndrome and albuminuria show an additive effect in modulating glomerular filtration rate in patients with Type 2 Diabetes Mellitus

BackgroundAlthough metabolic syndrome (MetSyn) or albuminuria (MA) most often occurs in concomitance in Type 2 Diabetes Mellitus patients (T2DM), their mode of interaction in increasing the risk of low glomerular filtration rate (GFR) has been poorly investigated.ObjectiveWe evaluated in a cohort of 1659 T2DM patients the relationship between MetSyn and MA in modulating the risk for low GFR. The risk of developing low GFR by graded number of MetSyn traits was also evaluated.MethodsThis was a cross-sectional study where 1659 T2DM patients were studied. Low GFR was defined as estimated-GFR (e-GFR) <60 ml min^?1 × 1.73 m^?2 (modification of diet in renal disease, MDRD, formula).Resultse-GFR progressively decreased from 91 ± 25 of patients MetSyn?MA?, to 82 ± 27 of patients MetSyn?MA+, 81 ± 24 of patients MetSyn+MA? and 76 ± 30 ml min^?1 × 1.73 m^?2 of patients MetSyn+MA+ (adjusted p < 0.0001). A progressive gradient of the frequency of patients with low e–GFR with concomitance of MetSyn and MA was also observed [MetSyn?MA? (6.1%), MetSyn?MA+ (15.3%), MetSyn+MA?(16.6%), MetSyn+MA+ (26.8%); p < 0.0001]. As compared to patients with MetSyn?MA?, the risk progressively increased to 2.80 (95% C.I. 1.46–5.37; p = 0.002) in MetSyn+MA?, to 2.83 (95% C.I. 1.12–7.10; p = 0.027) in MetSyn?MA+ and to 5.73 (95% C.I. 2.99–10.9; p < 0.0001) in MetSyn+MA+ patients. Estimated-GFR progressively decreased by number of MetSyn traits in the whole population (adjusted p < 0.0001).ConclusionsMetSyn or MA has an additive effect in increasing the risk of having low GFR in patients with T2DM. Furthermore, e-GFR is negatively affected by graded number of MetSyn traits independently of albuminuria.     

Screening for hypogonadism in diabetes 2008/9: results from the Cheshire Primary Care cohort

AimThere is increasing awareness of hypogonadism in men with type 2 diabetes but limited data from Primary Care.Subjects and methodsThe anonymised records of 6457 male patients aged 18–80 years with diabetes were accessed. Within the last 2 years 391 men (6.0% of total) underwent measurement of serum testosterone. Data search was performed through the centralised data facility afforded by EMIS^®, the majority GP systems provider in Cheshire.Results4.4% of type 2 diabetes men screened were frankly hypogonadal with a serum total testosterone of less than 8.0 nmol/l. For borderline hypogonadism (serum total testosterone 8–11.99 nmol/l) the proportion of type 2 diabetes men rose to 32.1%. Age adjusted mean (geometric) testosterone was lower in men with type 2 diabetes (13.6 nmol/l 95%CI: 13.1–14.2) vs type 1 diabetes (17.9 nmol/l; 95%CI 15.2–21.0), F = 10.3; p = 0.0014. For those screened age adjusted body mass index (BMI) was greater in type 2 diabetes at 30.7 (30.1–31.3) vs 28.4 (26.1–30.6) kg/m² in type 1 diabetes (F = 4.3; p = 0.04). Multiple linear regression analysis indicated that there was a statistically significant interaction (P = 0.014) between BMI and diabetes type in their relation with log testosterone. For persons with type 1 DM and type 2 DM, testosterone can be expected to decrease by 6% (P = 0.002) and by 1% (P = 0.002) respectively, for every one unit increment in BMI.ConclusionsThere is manifestly a subset of men with diabetes and androgen deficiency who could benefit from testosterone replacement. BMI has an independent influence on androgen status.     

Safety and tolerability of vildagliptin vs. thiazolidinedione as add-on to metformin in type 2 diabetic patients with and without mild renal impairment: A retrospective analysis of the GALIANT study

ObjectiveThis retrospective analysis assessed safety and tolerability of vildagliptin (Vilda) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients with normal renal function (GFR > 80 mL/min/1.73 m²) and mild renal impairment (GFR: >50 to ≤80 mL/min/1.73 m²).MethodsAdverse events (AE) from this 12-week, randomized, open-label study comparing Vilda 100 mg and thiazolidinediones (TZD) as an add-on therapy in patients with T2DM inadequately controlled (HbA_1c: 7–10%) on a stable dose of metformin (≥1000 mg/day) were analyzed.ResultsOf 2627 randomized patients, 1278 in the Vilda and 635 in the TZD groups had normal renal function; 463 in the Vilda and 230 in the TZD groups had mild renal impairment. Higher incidence of headache and rash was noted in both Vilda groups, whereas those with mild renal impairment receiving TZD experienced a higher incidence of peripheral edema and URI. Fewer patients in the Vilda group discontinued the study due to AEs compared to TZD group. Serious AEs were greater in TZD groups (normal: 2.4%; mild renal impairment: 3.0%) compared to Vilda groups (normal: 1.6%; mild renal impairment: 2.4%).ConclusionThe safety profile of Vilda or TZD as an add-on to metformin was similar in patients with mild renal impairment and normal renal function.     

Relationship between circulating irisin,renal function and body composition in type 2 diabetes

AimsChronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2DM) is associated with multifaceted energy dysmetabolism. We aim to study the relationship between renal function, body composition and irisin, the recently identified myokine which is involved in energy regulation, in T2DM.MethodsCirculating irisin and body composition were measured in 365 T2DM subjects across a wide range of renal function.ResultsCirculating irisin was significantly decreased in T2DM with renal insufficiency (77.4 ± 13.7 ng/ml in T2DM with eGFR ≥ 60 ml/min/1.73 m² versus 72.5 ± 14.9 ng/ml in those with eGFR < 60 ml/min/1.73 m², p = 0.001) and the reduction in irisin was most pronounced in stage 5 CKD patients. In T2DM with preserved renal function, irisin was correlated with age (r = − 0.242, p = 0.001) and pulse pressure (r = − 0.188, p = 0.002). Among those with renal insufficiency, irisin was correlated with BMI (r = 0.171, p = 0.022), fat mass (r = 0.191, p = 0.013), percentage of fat mass (r = 0.210, p = 0.007) and eGFR (r = 0.171, p = 0.020). Multivariate linear regression models revealed that variations in circulating irisin were mainly attributable to eGFR and age in T2DM with and without renal impairment, respectively.ConclusionOur observations suggest that the level of circulating irisin may be associated with renal function in T2DM. The role of reduced irisin in energy dysmetabolism in diabetic patients with renal insufficiency deserves further investigation.     

Changes over time in the prevalence and quality of care of type 2 diabetes in Italy: the Casale Monferrato surveys, 1988 and 2000

Background and aimsIn this study we assessed the prevalence of diagnosed type 2 diabetes and the quality of care during the period 1988–2000 in an Italian population.Methods and resultsTwo population-based surveys, using similar methods and centralized measurements, were conducted in 1988 and 2000 in a representative Italian area to identify people with known diabetes. The adjusted prevalence (reference, 2001 Italian population) was computed. The age- and sex-adjusted prevalence rates of diabetes in the population of Casale Monferrato were 2.13% (2.05–2.22) in 1988 and 3.07% (2.97–3.17) in 2000. In comparison with diabetic persons recruited in 1988 and independently of age and sex, persons recruited in 2000 had a lower likelihood of having HbA1c ≥7.0% (OR = 0.48; 0.42–0.56), diastolic blood pressure ≥80 mmHg (OR = 0.61; 0.49–0.75), LDL cholesterol ≥2.59 mmol/l (OR = 0.77; 0.63–0.93) and AER ≥20 μg/min (OR = 0.53; 0.45–0.61; they had a higher likelihood of having BMI ≥25 kg/m² (OR = 1.49; 1.2–1.74). However, 45.4% of patients still had HbA1c ≥7.0%, 80% blood pressure ≥130/80 mmHg and 79% LDL-cholesterol values ≥2.59 mmol/l.ConclusionMore than two-thirds of Italians with diabetes are now aged 65 years and more. The quality of control of glycemia, lipids and blood pressure improved and the prevalence of diabetic nephropathy decreased over time, although complete adherence to international guidelines has not yet been achieved.