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The performance of MDRD and CKD-EPI equations in diabetic patients with various degrees of albuminuria

Background and aims: Early changes in diabetic nephropathy involve increased urinary albumin excretion rate (AER) and/or a temporal increase in glomerular filtration rate (GFR, hyperfiltration), which are not necessarily inter-related. Both albuminuric and non- albuminuric pathways to renal impairment have been identified in diabetes, emphasizing the importance of monitoring appropriate markers when screening for diabetic nephropathy. The aim of this study was to compare the preformance of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease Study (MDRD) equation in estimating GFR in a cohort of diabetic patients with various degrees of albuminuria. Materials and methods: In a group of 842 diabetic patients GFR was estimated from standardized creatinine, with MDRD-Study and CKD-EPI equations, and their performance evaluated regarding clinical stages categories of albuminuria and chronic kidney disease (CKD). Results: A total of 842 adult diabetic patients (48, 2% males, 82% type 2 diabetes) were included in this study. Females were younger (median age: 55 vs 58, P=0.013), had lower serum creatinine (65±14 vs 80±18 μmol/L, P<0, 001), but no gender- associated differences in eGFR, calculated by either equation, HbA1c and albuminuria were found. Patients with normoalbuminuria had higher eGFR when calculated by CKD-EPI, than MDRD-Study equation [median (IQR): 103 (91-115) vs 97 (85- 113) mL/min/1.73 m2, p=0.006, n=364], which significantly influenced the prevalence of stage 1 CKD [eGFR>90 mL/min/1.73 m2: 76, 7% (CKD-EPI) vs. 65, 1% (MDRD- Study), P=0, 005]. There were no differences between the eGFR values derived by two equations in patients with micro-and macroalbuminuria, and more advanced staging of CKD.

diabetes; eGFR; albuminuria

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