The unrecognized prevalence of chronic kidney disease in diabetes

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 s...

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Published inNephrology, 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
LanguageEnglish
Published Oxford Oxford University Press 01.01.2006
Oxford Publishing Limited (England)
Subjects
Online AccessGet full text
ISSN0931-0509
1460-2385
DOI10.1093/ndt/gfi163

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Abstract 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.
AbstractList 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). 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 m(2). 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 (<or=120 micromol/l) in 54.7%. An abnormal serum creatinine (>or=120 micromol/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). 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.
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.
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).BACKGROUNDDiabetes 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).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 m(2).METHODSAll 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 m(2).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 (<or=120 micromol/l) in 54.7%. An abnormal serum creatinine (>or=120 micromol/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).RESULTSCreatinine 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 (<or=120 micromol/l) in 54.7%. An abnormal serum creatinine (>or=120 micromol/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).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.CONCLUSIONSUndiagnosed 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.
Author McElduff, Patrick
Foley, Robert N.
O'Donoghue, Donal J.
Hegarty, Janet
Kalra, Philip A.
New, John P.
Middleton, Rachel J.
Gibson, J. Martin
Cheung, Ching M.
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  surname: Middleton
  fullname: Middleton, Rachel J.
  organization: Department of Renal Medicine, Hope Hospital, Salford, UK
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  givenname: Robert N.
  surname: Foley
  fullname: Foley, Robert N.
  organization: Chronic Disease Research Group and University of Minnesota, USA
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  surname: Hegarty
  fullname: Hegarty, Janet
  organization: Department of Renal Medicine, Hope Hospital, Salford, UK
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  givenname: Ching M.
  surname: Cheung
  fullname: Cheung, Ching M.
  organization: Department of Renal Medicine, Hope Hospital, Salford, UK
– sequence: 5
  givenname: Patrick
  surname: McElduff
  fullname: McElduff, Patrick
  organization: Evidence of Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, UK and
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  givenname: J. Martin
  surname: Gibson
  fullname: Gibson, J. Martin
  organization: Department of Diabetes and Endocrinology, Hope Hospital, Salford, UK
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  givenname: Philip A.
  surname: Kalra
  fullname: Kalra, Philip A.
  organization: Department of Renal Medicine, Hope Hospital, Salford, UK
– sequence: 8
  givenname: Donal J.
  surname: O'Donoghue
  fullname: O'Donoghue, Donal J.
  organization: Department of Renal Medicine, Hope Hospital, Salford, UK
– sequence: 9
  givenname: John P.
  surname: New
  fullname: New, John P.
  organization: Department of Diabetes and Endocrinology, Hope Hospital, Salford, UK
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Issue 1
Keywords 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
Language English
License CC BY 4.0
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-c380t-54831ca387d17abb4132a05c3e9d729b35641c996bba6af7bfd9ffc0d7e622a3
Notes local:gfi163
Corresponding and offprint requests to: Rachel J. Middleton, Specialist Registrar in Nephrology, Department of Renal Medicine, Hope Hospital, Stott Lane, Salford M6 8HD, UK. Email: Rachel.middleton@srht.nhs.uk
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Snippet Background. Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes...
Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes guidelines in the...
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SubjectTerms 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
Title The unrecognized prevalence of chronic kidney disease in diabetes
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