How Reliable Is Estimation of Glomerular Filtration Rate at Diagnosis of Type 2 Diabetes?
Open accessAbstract
OBJECTIVE: The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations previously have been recommended to estimate glomerular filtration rate (GFR). We compared both estimates with true GFR, measured by the isotopic (51)Cr-EDTA method, in newly diagnosed, treatment-naïve subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 292 mainly normoalbuminuric (241 of 292) subjects were recruited. Subjects were classified as having mild renal impairment (group 1, GFR <90 ml/min per 1.73 m(2)) or normal renal function (group 2, GFR >/=90 ml/min per 1.73 m(2)). Estimated GFR (eGFR) was calculated by the CG and MDRD equations. Blood samples drawn at 44, 120, 180, and 240 min after administration of 1 MBq of (51)Cr-EDTA were used to measure isotopic GFR (iGFR). RESULTS: For subjects in group 1, mean (+/-SD) iGFR was 83.8 +/- 4.3 ml/min per 1.73 m(2). eGFR was 78.0 +/- 16.5 or 73.7 +/- 12.0 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -11.1 to -0.6 using CG and -14.4 to -7.0 using MDRD. Ninety-five percent limits of agreement (mean bias +/- 2 SD) were -37.2 to 25.6 and -33.1 to 11.7, respectively. In group 2, iGFR was 119.4 +/- 20.3 ml/min per 1.73 m(2). eGFR was 104.4 +/- 26.3 or 92.3 +/- 18.7 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -17.4 to -12.5 using CG and -29.1 to -25.1 using MDRD. Ninety-five percent limits of agreement were -54.4 to 24.4 and -59.5 to 5.3, respectively. CONCLUSIONS: In newly diagnosed type 2 diabetic patients, particularly those with a GFR >/=90 ml/min per 1.73 m(2), both CG and MDRD equations significantly underestimate iGFR. This highlights a limitation in the use of eGFR in the majority of diabetic subjects outside the setting of chronic kidney disease.
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Renal assessment through inulin and p-amino hippurate clearance is impractical in large trials.
“Renal assessment through inulin and p-amino hippurate clearance is impractical in large trials and estimated GFR has limitations [13].”
From Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study (2011) · cites this paper as [13]
The Results section says eGFR has significant limitations, supporting that part of the citing sentence. The Clinical and Laboratory methods describe measurement using 51Cr-EDTA, but our copy does not say that inulin and p-amino hippurate clearance are impractical in large trials. Searches for those clearance methods and for the practicality of direct GFR measurement found no supporting passage. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEstimated GFR may underestimate true glomerular filtration rate, particularly at >90 ml min−1 1.73 m−2.
“Although estimated GFR may underestimate true glomerular filtration rate [13], particularly at >90 ml min -1 1.73 m -2 , our analyses focused on changes over time and between treatments, rather than absolute values.”
Estimated GFR has limitations.
“Renal assessment through inulin and p-amino hippurate clearance is impractical in large trials and estimated GFR has limitations [13].”
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Brenner, B. M., Cooper, M. E., de Zeeuw, D., Keane, W. F., Mitch, W. E., Parving, H.-H., Remuzzi, G., Snapinn, S. M., Zhang, Z., & Shahinfar, S. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011161 · Cited by 7,493 · see citing works
The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes
Parving, H.-H., Lehnert, H., Bröchner-Mortensen, J., Gomis, R., Andersen, S., & Arner, P. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011489 · Cited by 2,873 · see citing works
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on behalf of the FIELD Study investigators, Davis, T. M. E., Ting, R., Best, J. D., Donoghoe, M. W., Drury, P. L., Sullivan, D. R., Jenkins, A. J., O’Connell, R. L., Whiting, M. J., et al. (2011) · Diabetologia · doi:10.1007/s00125-010-1951-1 · Cited by 371 · see citing works
Ting, R.-D., Keech, A. C., Drury, P. L., Donoghoe, M. W., Hedley, J., Jenkins, A. J., Davis, T. M. E., Lehto, S., Celermajer, D., Simes, R. J., et al. (2012) · Diabetes Care · doi:10.2337/dc11-1109 · Cited by 119 · see citing works
- Authors
- Chudleigh, R. A., Dunseath, G., Evans, W., Harvey, J. N., Evans, P., Ollerton, R., & Owens, D. R.
- Affiliations
- University Hospital Llandough (GB)
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2007-02-01
- Volume
- 30
- Issue
- 2
- Pages
- 300-305
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2086381113
- Cited by
- 49
- References
- 2
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2016: 1 · 2015: 4 · 2014: 1 · 2013: 3 · 2012: 4
- FWCI
- 4.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- glomerular filtration rate estimation, type 2 diabetes, Cockcroft-Gault formula, MDRD equation, 51Cr-EDTA, renal dysfunction, methodological bias, limits of agreement, newly diagnosed diabetes, normoalbuminuria, treatment-naive patients, renal function assessment, CKD risk stratification
- MeSH terms
- Aged, Albuminuria, Blood Pressure, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Middle Aged, Reproducibility of Results, Body Mass Index
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