Early glomerular filtration rate loss as a marker of diabetic nephropathy

George Jerums, Elif Ekinci, Sianna Panagiotopoulos, Richard MacIsaac

Research output: Contribution to journalArticleResearchpeer-review

Abstract

In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2 (chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.
Original languageEnglish
Pages (from-to)40-44
Number of pages5
JournalUS Endocrinology
Volume8
Issue number1
DOIs
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

Diabetic Nephropathies
Glomerular Filtration Rate
Chronic Renal Insufficiency
Diet Therapy
Type 1 Diabetes Mellitus
Kidney
Cystatin C
Type 2 Diabetes Mellitus
Creatinine
Epidemiology
Costs and Cost Analysis

Cite this

Jerums, George ; Ekinci, Elif ; Panagiotopoulos, Sianna ; MacIsaac, Richard. / Early glomerular filtration rate loss as a marker of diabetic nephropathy. In: US Endocrinology. 2012 ; Vol. 8, No. 1. pp. 40-44.
@article{7ce14887ed814953a00ae09a9f1f9e95,
title = "Early glomerular filtration rate loss as a marker of diabetic nephropathy",
abstract = "In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2 (chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.",
author = "George Jerums and Elif Ekinci and Sianna Panagiotopoulos and Richard MacIsaac",
year = "2012",
doi = "10.17925/USE.2012.08.01.40",
language = "English",
volume = "8",
pages = "40--44",
journal = "US Endocrinology",
issn = "1758-3918",
publisher = "Touch Medical Media Ltd",
number = "1",

}

Jerums, G, Ekinci, E, Panagiotopoulos, S & MacIsaac, R 2012, 'Early glomerular filtration rate loss as a marker of diabetic nephropathy', US Endocrinology, vol. 8, no. 1, pp. 40-44. https://doi.org/10.17925/USE.2012.08.01.40

Early glomerular filtration rate loss as a marker of diabetic nephropathy. / Jerums, George; Ekinci, Elif; Panagiotopoulos, Sianna; MacIsaac, Richard.

In: US Endocrinology, Vol. 8, No. 1, 2012, p. 40-44.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Early glomerular filtration rate loss as a marker of diabetic nephropathy

AU - Jerums, George

AU - Ekinci, Elif

AU - Panagiotopoulos, Sianna

AU - MacIsaac, Richard

PY - 2012

Y1 - 2012

N2 - In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2 (chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.

AB - In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2 (chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.

UR - http://www.scopus.com/inward/record.url?scp=84868362776&partnerID=8YFLogxK

U2 - 10.17925/USE.2012.08.01.40

DO - 10.17925/USE.2012.08.01.40

M3 - Article

VL - 8

SP - 40

EP - 44

JO - US Endocrinology

JF - US Endocrinology

SN - 1758-3918

IS - 1

ER -