The unrecognized prevalence of chronic kidney disease in diabetes

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 1; pp. 88 - 92
• Main Authors: Middleton, Rachel J., Foley, Robert N., Hegarty, Janet, Cheung, Ching M., McElduff, Patrick, Gibson, J. Martin, Kalra, Philip A., O'Donoghue, Donal J., New, John P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2006; Oxford Publishing Limited (England)
• Subjects: Adult; Age Distribution; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Associated diseases and complications; Biological and medical sciences; Blood Glucose - analysis; Cohort Studies; Comorbidity; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; diabetic kidney disease; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - epidemiology; Emergency and intensive care: renal failure. Dialysis management; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; estimated glomerular filtration rate; Female; Glomerular Filtration Rate; Humans; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Function Tests; Kidneys; Logistic Models; Male; Medical sciences; Middle Aged; modification of diet in renal disease (MDRD) study equation; Nephrology. Urinary tract diseases; Prevalence; Probability; Prognosis; Risk Assessment; sensitivity; serum creatinine; Severity of Illness Index; Sex Distribution; Tumors of the urinary system; United Kingdom - epidemiology; Endocrinopathy; Kidney disease; Creatinine; diabetic kidney disease; Urinary system disease; Glomerular filtration; Prevalence; estimated glomerular filtration rate; Hemodialysis; Diabetes mellitus; serum creatinine; Extrarenal dialysis; Renal failure; sensitivity; modification of diet in renal disease (MDRD) study equation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfi163

Background. Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes guidelines in the UK recommend annual urinary albumin and serum creatinine determinations to screen for diabetic kidney disease. The aim of this study was to estimate the burden of CKD in patients with diabetes and examine the ability of serum creatinine and albuminuria to detect clinically meaningful CKD compared with estimated glomerular filtration rate (eGFR). Methods. All adults known to have diabetes in primary and secondary care in Salford, UK, alive with independent renal function on 1 January 2004 were included in this observational study (n = 7596). Demographic and laboratory parameters were obtained from the Electronic Patient Record. eGFR was determined using the 4-variable modification of diet in renal disease (MDRD) formula. Clinically meaningful CKD was defined as an eGFR <60 ml/min/1.73 m2. Results. Creatinine and albuminuria were measured in the preceding 2 years in 82.3 and 55.2% of subjects, respectively. In patients with CKD, normoalbuminuria was present in 48.8%, and serum creatinine was normal (≤120 µmol/l) in 54.7%. An abnormal serum creatinine (≥120 µmol/l) had a sensitivity and specificity of 45.3 and 100%, respectively, to identify CKD. The combination of abnormal creatinine and albuminuria had an improved performance but still failed to detect a large number with CKD (sensitivity 82.4%, specificity 75.4%). Serum creatinine failed to identify CKD more often in females (OR 8.22, CI 6.56–10.29). Conclusions. Undiagnosed CKD is common in diabetes. Current screening strategies, based on creatinine or albuminuria, fail to identify a considerable number of subjects with CKD. Incorporating eGFR into screening for CKD would identify individuals earlier in the natural history of the disease and enable early effective treatment to delay progression of CKD.