Detecting chronic kidney disease in diabetic adults by estimating glomerular filtration rate and Serum Creatinine

  • Ahmed Kh. Mohammed Almaawi Senior Specialist Physician, Studies and Research Department, Commission of Medical Tertiary Centers, Ministry Of Health, Baghdad, Iraq.

Abstract

Objective: To assess CKD prevalence and risk factors including socio-demography among diabetics by estimating GFR rather than serum creatinine (sCr).
Methods: A cross-sectional study was conducted in Dec. 15 2019 through Aug. 15 2020, among 800 diabetics attending tertiary diabetes centers, Baghdad. Data was collected by self-administered questionnaire. SPSS was used for data analysis by (mean, standard deviation and T-test) for quantitative variables and (frequency, percentage, Chi-square test and Kappa index) for qualitative variables. P-Value less than 0.05 was considered significant. 
Results: 800 diabetics for last 5-40 years, 95.6% with type2. Aged 52.1±13.2 years, with male: female ratio 1.03:1, 63.6% were with no income, sCr level was 0.86±0.3 mg/dl, and eGFR by Cockcroft Gault (CG) and CKD-EPI equations was 100.4±36.5 & 92.2±25.5 ml/min/1.73m2 respectively. CKD prevalence based on sCr, and eGFR assessed by above equations was 13.3%, 20% and 15.9% respectively (p<0.001). Those with CKD were hypertensive, females, and living in peripheries.
Conclusions: Diabetic patients, mainly those with risk factors are more likely to develop CKD. It is better to detect CKD intially by estimating the GFR, rather than serum creatinine level alone. Furthermore, using CKD-EPI equation might be better than the CG formula to estimate the GFR.
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References

1- Omran A. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 2005: 83(4); 731–757. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690264/#.
2- Stenvinkel P. Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. Journal of Int Med 2010: 268; 456–467. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2010.02269.
3- Alwan A. Chronic Non-Communicable Diseases. In: Health in Iraq: The Current Situation, Our Vision for the Future and Areas of Work, 2nd ed. BGD (Iraq): Al-Adib Press; 2004, p. 31-40. Available online at: https://www.who.int/hac/crises/irq/background/Iraq_Health_in_Iraq_second_edition.pdf?ua=1.
4- Bakris G, Ritz E. The message for World Kidney Day 2009: hypertension and kidney disease— a marriage that should be prevented. J Hum Hypertens 2009: 23; 222–225. Available at: https://www.nature.com/articles/jhh2008169.
5- Pearson ER, McCrimmon RJ. Diabetes mellitus. In: Walker BR, Colledge NR, Ralston SH et al. Davidson’s Principles &practice of Medicine, 22nd ed. Edinburgh: Elsevier; 2014, p.797-836.
6- Powers AC, Niswender KD, Evans-Molina C. Diabetes Mellitus: Diagnosis, Classification and Pathology. In: Jameson JL, Fauci AS, Kasper DL et al, Harrison’s Principles Of Internal Medicine, 20thed. New York: McGrow-Hill Education; 2018, p. 2850-2859.
7- World Health Organization. Country and regional data on diabetes: WHO Eastern Mediterranean Region [Internet].Geneva, Switzerland; 2020 [Cited 2020 Aug 25]. Available at: https://www.who.int/diabetes/facts/world_figures/en/index2.html.
8- Al-Obaidi S, Abdulrazaq M, Muhammed S et al. Diagnosis of diabetes mellitus in patients with tuberculosis. In: Iraqi MOH National Tuberculosis Program. Tuberculosis in Patients with Diabetes Mellitus: A guide of management, 1st ed. Iraq: MOH; 2019, p. 2-3: 7-8. Available at: http://phd.iq/LionImages/PDFStore/Tuberculosis%20in%20Patients%20with%20DM%20final.pdf
9- Powers AC, Stafford JM, Rickels MR. Diabetes Mellitus: Complications .In: Jameson JL, Fauci AS, Kasper DL et al, Harrison’s Principles Of Internal Medicine, 20th ed. New York: McGrow-Hill Education; 2018, p. 2875-2883.
10- Crandall J, Shamoon H. Diabetes Mellitus. In: Goldman L, Shafer AI, Goldman-Cesil Medicine, 25th ed. Philadelphia: Elsevier; 2016, p. 1527-1548.
11- Bargman JM, Skorecki KL. Chronic Kidney Disease. In: Jameson JL, Fauci AS, Kasper DL, et al, Harrison’s Principles Of Internal Medicine, 20th ed. New York: McGrow-Hill Education; 2018, p. 2111-2121.
12- Gale E, Anderson J. Diabetes mellitus. In: Kumar P, Clark M, Kumar & Clark’s Clinical Medicine, 9th ed. Edinburgh: Elsevier; 2017, p. 1241-1276.
13- Alicic R, Rooney M, Tuttle K. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol 2017:12; 2032-2045. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718284/.
14- Karalliedde J, Viberti G. Microalbuminuria and cardiovascular risk. AJH 2004: 17; 986–993. Available at: https://academic.oup.com/ajh/article/ 17/10/986/107224.
15- Alaini A, Malhotra D, Rondon-Berrios H, et al. Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate. World J Methodol 2017: 7(3); 73-92. Available at: http://dx.doi.org/10.5662/wjm.v7.i3.73.
16- Grill A, Brimble S. Approach to the detection and management of chronic kidney disease: What primary care providers need to know. Can Fam Physician 2018:64(10); 728-735. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184972/.
17- Upadhyay A, Inker L, levey A. Chronic Kidney Disease: definition, classification and approach to management. In: Turner N, Lameire N, Goldsmith D, et al. Oxford Textbook of Clinical Nephrology, 4th ed. Glasgow: Bell &Bain; 2016, p. 743-755.
18- Levey A. Becker C, Inker, L. Glomerular Filtration Rate and Albuminuria for Detection and Staging of Acute and Chronic Kidney Disease in Adults: A Systematic Review. JAMA 2015: 313 (8); 837–846. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410363/.
19- Mitch W. Chronic Kidney Disease. In: Goldman L, Shafer A, Goldman-Cesil Medicine, 25th ed. Philadelphia: Elsevier; 2016, p.833-841.
20- Berl T, Henrich, W. Kidney-Heart Interactions: Epidemiology, Pathogenesis, and Treatment. Clinical J Am Society Nephrology 2006: 1; 8–18. Available at: https://cjasn.asnjournals.org/content/1/1/8.
21- Goldsmith D. Cardiovascular disease and Chronic Kidney Disease in the developed world. In: Turner N, Lameire N, Goldsmith D, et al. Oxford Textbook of Clinical Nephrology, 4th ed. Glasgow: Bell &Bain; 2016, p. 777-780.
22- Yaqoob M, Ashman N. Kidney and urinary tract disease. In: Kumar P, Clark M, Kumar & Clark’s Clinical Medicine, 9th ed. Edinburgh: Elsevier; 2017, p.723-794.
23- Levey A, Stevens L, Schmid C et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med 2009: 150(9); 604-612. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763564/.
24- Ravera, M, Noberasco G, Weiss U, et al. CKD Awareness and Blood Pressure Control in the Primary Care Hypertensive Population. Am J Kidney Dis 2010: 57(1); 71–77. Available at: https://www.ajkd.org/article/S0272-6386(10)01395-1/fulltext.
25- McFarlane P, Cherney D, Gilbert R, et al. Chronic Kidney Disease in Diabetes. CJD 2018: 42; 201–209. Available at: https://www.canadianjournalofdiabetes.com/article/S1499-2671(17)30985-1/fulltext.
26- Komenda P, Ferguson T, Macdonald K, et al. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis 2014; 63(5): 789-797. Available at: https://www.ajkd.org/article/S0272-6386(14)00024-9/fulltext.
27- Du Bois D, Du Bois E. A formula to estimate approximate surface area if height and weight be known. Arch Int. Med 1917; 17: 863-871. Available at: https://www.scirp.org/(S(i43dyn45teexjx455qlt3d2q))/reference/ReferencesPapers.aspx?ReferenceID=1332732.
28- Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives – a position statement from kidney disease improving global outcomes. Kidney International 2007: 72(3); 247–259. Available at: https://www.kidney-international.org/article/S0085-2538(15)52649-5/fulltext.
29- Stevens L, Fares G, Fleming J, et al. Low Rates of Testing and Diagnostic Codes Usage in a Commercial Clinical Laboratory: Evidence for Lack of Physician Awareness of Chronic Kidney Disease. JASN 2005: 16(8); 2439–2448. Available at: https://jasn.asnjournals.org/content/16/8/2439.
30- Narenpitak S, Narenpitak A. Prevalence of Chronic Kidney Disease in type 2 Diabetes in Primary Health Care unit of Udon Thani province, Thailand. J Med Assoc Thai 2008: 91(10); 1505-1513. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.7206&rep=rep1&type=pdf.
31- Zaman S. Detection of Chronic Kidney Disease by Using Different Equations of Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analysis. Cureus 2017: 9(6); e1352. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510968/.
32- Bouzid C, Smida H, Kacem A, et al. Renal failure in Tunisian patients with type 2 diabetes: Frequency and related factors. La Tunisie Medicale 2011: 89(1); 10–15. Available at: https://www.latunisiemedicale.com/article-medicale-tunisie_1502_en.
33- Fiseha T, Kassim M, Yemane T. Chronic kidney disease and under diagnosis of renal Insufficiency among diabetic patients attending a hospital in Southern Ethiopia. BMC Nephrology 2014: 15; 198. Available at: https://bmcnephrol.biomedcentral.com/track/pdf/10.1186/1471-2369-15-198.
34- De Boer I, Rue T, Hall Y, et al. Temporal Trends in the Prevalence of Diabetic Kidney Disease in the United States. JAMA 2011: 305(24); 2532–2539. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731378/.
35- Nakata J, Ohsawa I, Onda K. et al. Risk of Overestimation of Kidney Function Using GFR‐Estimating Equations in Patients with Low Inulin Clearance. J Clinical Lab Anal 2012; 26(4): 248-253. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6807624/.
36- Bradshaw C, Kondal D, Montez-Rath M, et al. Early detection of chronic kidney disease in low-income and middle-income countries: development and validation of a point-of-care screening strategy for India. BMJGH 2019: 4(5); e001644. Available at: https://gh.bmj.com/content/4/5/e001644.long.
37- Hooi LS, Ong LM, Ahmad G., et al. A population-based study measuring the prevalence of chronic kidney disease among adults in West Malaysia. Kidney International 2013: 84(5); 1034–1040. Available at: https://www.kidney-international.org/article/S0085-2538(15)56071-7/fulltext.
38- Jolly S, Navaneethan S, Schold J, et al. Chronic kidney disease in Electronic Health Record Problem List: Quality of Care, ESRD, and mortality. Am J Nephrology 2014; 39: 288–296. Available at: https://www.karger.com/Article/Fulltext/360306
39- Kazancioglu R. Risk factors for chronic kidney disease: an update. Kidney Int Suppl 2013: 3(4); 368–371. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089662/.
40- Hemmelgarn B, Zhang J, Manns B, et al. Progression of kidney dysfunction in community-dwelling elderly. Kidney International. 2006: 69(12); 2155–2161. Available at: https://www.kidney-international.org/article/S0085-2538(15)51433-6/fulltext.


41- Ene-Iordache B, Perico N, Bikbov B, et al. Chronic Kidney Disease and Cardiovascular Risk in Six Regions of the World (ISN-KDDC): a cross-sectional study. Lancet Glob Health 2016: 4(5); 307–319. Available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)00071-1/fulltext
42- Parameswaran S, Geda S, Rathi M, et al. Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome. Natl Med J India 2011: 24(4); 208–213. Available at: https://pubmed.ncbi.nlm.nih.gov/22208139/.
43- George C, Mogueo A, Okpechi I, et al. Chronic kidney disease in low-income to middle-income countries: the case for increased screening. BMJ Glob Health 2017: 2; e000256. Available at: https://gh.bmj.com/content/2/2/e000256.
44- Mansour A, Douri F. Diabetes in Iraq: Facing the Epidemic. A systematic Review. Wulfenia 2015: 22(3); 258-273. Available at:
https://www.researchgate.net/publication/280084146_Diabetes_in_Iraq_Facing_the_Epidemic_A_systematic_Review.
45- Kitiyakara C, Yamwong S, Vathesatogkit P, et al.: The impact of different GFR estimating equations on the prevalence of CKD and risk groups in a Southeast Asian cohort using the new KDIGO guidelines. BMC Nephrology 2012: 13; 1. [Cited 2020 Aug 25]. Available at: https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-13-1.
Published
2021-02-26
How to Cite
ALMAAWI, Ahmed Kh. Mohammed. Detecting chronic kidney disease in diabetic adults by estimating glomerular filtration rate and Serum Creatinine. Journal of Contemporary Medical Sciences, [S.l.], v. 7, n. 1, p. 34-39, feb. 2021. ISSN 2413-0516. Available at: <http://www.jocms.org/index.php/jcms/article/view/926>. Date accessed: 21 jan. 2022. doi: https://doi.org/10.22317/jcms.v7i1.926.