Diabetes Obesity and Metabolism, Год журнала: 2024, Номер 26(6), С. 2501 - 2504

Опубликована: Март 6, 2024

Chronic kidney disease (CKD) is a common complication of type 2 diabetes (T2D) characterized by albuminuria and progressive decline in the glomerular filtration rate (GFR).1 CKD setting T2D can be result diabetic nephropathy, non-diabetic renal disease, or combination these factors.2 Regardless aetiology, early diagnosis enables interventions to slow GFR decline, including discontinuation nephrotoxic medications initiation renoprotective medications.3, 4 Reduced also necessitates dose adjustments for renally excreted medications, several antidiabetic agents.5 Improper adjustment lead adverse drug reactions, which are but largely preventable cause hospitalization.6 Therefore, accurate assessment crucial effective management people with T2D. Kidney Disease Improving Global Outcomes (KDIGO) guidelines from 2012 recommend using estimated (eGFR) equations based on creatinine and/or cystatin C evaluation CKD.7 Creatinine least expensive option biomarker choice most clinical settings. Cystatin less common, some settings (notably Sweden) have incorporated it into routine care. The main limitation endogenous markers that their concentration influenced factors other than function. As 'non-renal factors' unique each marker, combining multiple single equation reduces influence non-renal factors. Unsurprisingly, eGFR combine been shown outperform either marker alone general population,8 although this may not true T2D.9 practice those developed Epidemiology Collaboration (CKD-EPI). original CKD-EPI (2009 CKD-EPIcre), (2012 CKD-EPIcys), CKD-EPIcomb) replaced alternative both United States Europe.10, 11 In response criticisms race as variable, group revised exclude race, yielding 2021 CKD-EPIcre CKD-EPIcomb.12 Similarly, CKD-EPIcys was sex 2023 CKD-EPIcys.13 National societies now CKD-EPIcomb over earlier counterparts.14 However, there an ongoing debate about whether recommendation appropriate European populations, Europe continue use 2009 CKD-EPIcre. Given apparent success C, has suggested incorporating additional could further reduce impact 2020, panel (2020 CKD-EPIpanel), includes creatinine, β-trace protein (BTP) β2-microglobulin (B2M).15 Importantly, authors found inclusion BTP B2M resulted strong performance across patient subgroups without explicit race. purpose present study compare different identify equation(s) among adults This post-hoc analysis two trials ('DapKid' 'LIRALBU') performed at Steno Diabetes Center Copenhagen, Herlev, Denmark.16, 17 Both enrolled non-Black (age ≥18 years) T2D, participants who completed were included current analysis. relevant difference between cohorts DapKid trial ≥45 ml/min/1.73 m2, whereas LIRALBU ≥30 m2. A full list exclusion criteria information study's design ClinicalTrials.gov (NCT02914691 NCT02545738). studies, underwent measurements before any planned interventions. measured Copenhagen plasma clearance chromium-51-labelled ethylenediamine tetraacetic acid four-point sampling (180, 200, 220 240 min after injection). Demographic blood samples collected immediately measurement, laboratory standard assays. traceable enzymatic assay [coefficient variation (CV): 4%], immunoturbidimetric (CV: 5%), nephelometry 5%) immunoturbidimetry 4%). CKD-EPIcomb), CKD-EPIpanel) (Table S1). Continuous variables presented median interquartile range, differences evaluated Wilcoxon rank-sum test. Categorical number percentage participants, Fisher's exact Performance relative (mGFR) assessed bias [median value (eGFR-mGFR)] values within ±30% (P30) ± 20% (P20) mGFR values. Bland-Altman plots generated represent levels mGFR. Based visual inspection plots, sensitivity evaluate <120 total, 36 27 trial, combined sample size 63 (Figure Nine individuals participated did complete trials, available characteristics similar final population (data shown). Clinical cohort Table 1. had age 66 years, body mass index 31 kg/m2, 76 glycated haemoglobin 65 mmol/mol, 14.3% female. Compared higher (81 vs. 69 p = .09) (68 58 .001). Otherwise, no substantial cohorts. 2. Bias positive negative all equations. smallest (closest 0) (+0.4 m2) (−0.7 m2); P30 highest (90.5%) 2020 CKD-EPIpanel (93.7%); P20 (74.6%) (79.4%). according Figure S2. Seven ≥120 remaining 56 (mGFR switching S3. Switching would mean eGFR, lower eGFR. conclusion, we relatively low P20, indicating high overall accuracy large interindividual variation. C-based yielded bias, probably because population, such obesity inflammation, contribute increased concentration.18, 19 Removal variable (more positive) worse P30, removal negative) P30. Despite poor equations, small (close alone, demonstrating strength markers. unaffected explained reweighting coefficient. consistent (highest P20), substantially Interestingly, >120 These cases stages damage experiencing hyperfiltration, explain lag decreased concentrations (increased eGFR). Excluding metrics, readers should aware phenomenon when interpreting (or mGFR) findings, creatinine-cystatin if unavailable. Providers recognize conclusions drawn non-Black, primarily male advanced >30 We test Function Consortium (EKFC), more populations.20 will always depend specific scenario presence All accepted responsibility content manuscript approved its submission. conflicts interest declare. peer review history article https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/dom.15536. De-identified data made upon reasonable request. Those submitting request required send protocol, plan statistical analysis, access agreement ensure data. S1. Flow diagram participant completion study. eGFR-mGFR versus equation. List estimate rate. Mean change Please note: publisher responsible functionality supporting supplied authors. Any queries (other missing content) directed corresponding author article.

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