Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects
Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects Vincent Rigalleau , MD, PHD 1 2 , Catherine Lasseur , MD 1 3 , Christelle Raffaitin 1 2 , Caroline Perlemoine , MD 1 2 , Nicole Barthe , PHARMD 1 4 , Philippe Chauveau , MD 1 3 , Christian Combe , MD, PHD 1...
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| Vydáno v: | Diabetes care Ročník 29; číslo 7; s. 1491 - 1495 |
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| Hlavní autoři: | , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
Alexandria, VA
American Diabetes Association
01.07.2006
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| Témata: | |
| ISSN: | 0149-5992, 1935-5548 |
| On-line přístup: | Získat plný text |
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| Shrnutí: | Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects
Vincent Rigalleau , MD, PHD 1 2 ,
Catherine Lasseur , MD 1 3 ,
Christelle Raffaitin 1 2 ,
Caroline Perlemoine , MD 1 2 ,
Nicole Barthe , PHARMD 1 4 ,
Philippe Chauveau , MD 1 3 ,
Christian Combe , MD, PHD 1 3 and
Henri Gin , MD, PHD 1 2
1 Université de Bordeaux 2, Victor Segalen, Bordeaux, France
2 Department of Nutrition and Diabetes, Hôpital Haut-Lévêque, Pessac, France
3 Department of Nephrology, Hôpital Pellegrin, Bordeaux, France
4 Department of Nuclear Medicine, Hôpital Pellegrin, Bordeaux, France
Address correspondence and reprint requests to Vincent Rigalleau, Nutrition-Diabétologie, Hôpital Haut-Lévêque, Avenue de
Magellan, 33600 Pessac, France. E-mail: vincent.rigalleau{at}wanadoo.fr
Abstract
OBJECTIVE —Hyperglycemia increases glomerular filtration rate (GFR), but the influence of HbA 1c (A1C) on GFR and GFR’s prediction by recommended equations remains to be determined.
RESEARCH DESIGN AND METHODS —In 193 diabetic patients, we searched for an association between A1C and isotopically measured GFR (51Cr-EDTA) and their
predictions by the Cockcroft and Gault formula (CG) and the modification of diet in renal disease (MDRD) equation. Their accuracy
for the diagnosis of moderate (GFR <60 ml/min per 1.73 m 2 ) or severe (GFR <30 ml/min per 1.73 m 2 ) renal failure was compared from receiver operating characteristic (ROC) curves, before and after categorizing the patients
as well (A1C ≤8%) or poorly controlled.
RESULTS —The mean GFR was 57.0 ± 34.8 ml/min per 1.73 m 2 and was well correlated with both estimations (CG r = 0.75, MDRD r = 0.83; P < 0.05). The areas under the ROC curves were higher with the MDRD ( P < 0.05). A1C was correlated ( P < 0.001) with the GFR ( r = 0.29), MDRD ( r = 0.38), CG ( r = 0.26), and the absolute differences between the GFR and their CG but not MDRD estimations ( r = 0.17, P < 0.05). Each +1% A1C was associated with +6.0 ml/min per 1.73 m 2 GFR (CG +5.6, MDRD +5.3). After separating well-controlled ( n = 88, A1C 7.0 ± 0.7%) and poorly controlled ( n = 105, 9.6 ± 1.3%) patients, the diagnostic accuracies were better ( P < 0.05) for the MDRD, except for the diagnosis of moderate renal failure in well-controlled patients (NS).
CONCLUSIONS —GFR and its estimations correlate with A1C. Although the relations between GFR and its estimations were not affected by the
degree of glucose control, the precision and diagnostic accuracy of the CG formula were diminished for A1C >8%. The MDRD equation
was more accurate and robust in diabetic patients with impaired renal function.
CG, Cockcroft and Gault formula
GFR, glomerular filtration rate
MDRD, modification of diet in renal disease
ROC, receiver operating characteristic
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
Accepted March 30, 2006.
Received February 21, 2006.
DIABETES CARE |
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| Bibliografie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
| ISSN: | 0149-5992 1935-5548 |
| DOI: | 10.2337/dc06-0407 |