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Estimated glomerular filtration rate and albuminuria: true predictors of cardiovascular events in obese patients with type 2 diabetes?

Validität der eGFR als Prädiktor kardiovaskulärer Ereignisse bei adipösen Patienten mit Diabetes mellitus

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Zusammenfassung

Grundlagen

Rezente Daten zeigen, dass die, mit der MDRD-Formel errechnete, glomeruläre Filtrationsrate (eGFR) bei adipösen Patienten falsch niedrig ist. In dieser Studie wurde daher evaluiert, ob dieser Berechnungsfehler bei adipösen Patienten Einfluss auf den Wert der eGFR als Risikomarker für kardiovaskuläre Ereignisse nimmt.

Methodik

Der prognostische Wert der eGFR (errechnet mittels MDRD, Cockroft-Gault und CKD-EPI) hinsichtlich kardiovaskulärer Ereignisse wurde in einem Kollektiv aus 988 an Diabetes mellitus erkrankten Patienten mit Hilfe von Cox-Regressionsmodellen berechnet (Variablen im Modell: HbA1c, Alter, Diabetesdauer, eGFR und Albumin-Kreatinin-Quotient; Endpunkt: ungeplante kardiovaskuläre Hospitalisation). Nach Berechnung des Modells im gesamten Kollektiv erfolgte eine Aufteilung und Neuberechnung in 4 Gruppen (Gruppe 1, 475 Pat; eGFR > 60 ml/min; BMI < 30 kg/m2,Gruppe 2, 274 Pat; eGFR > 60 ml/min; BMI > 30 kg/m2, Gruppe 3, 110 Pat; eGFR < 60 ml/min; BMI > 30 kg/m2 und Gruppe 4, 129 Pat.; eGFR < 60 ml/min; BMI < 30 kg/m2).

Ergebnisse

Im Cox-Modell (mittlere Nachbeobachtungszeit 29 Monate; 95 Ereignisse), welches für das gesamte Kollektiv gerechnet wurde, waren die Albumin-Kreatinin-Ratio (HR 1,001, p < 0,001, CI 1,000–1,001) und die eGFR (HR 0,957, p < 0,001, CI 0,963–0,987) prädiktiv für den Endpunkt. Bei adipösen Patienten (BMI > 30) hingegen verliert die GFR ihren prädiktiven Wert. Weiters war die Zahl der Patienten welche trotz einer eGFR < 60 ml/min eine Normoalbuminurie hatten unerwartet hoch (59,4 %).

Schlussfolgerungen

Bei adipösen Patienten bewirkt der Berechnungsfehler der eGFR einen Verlust des prädiktiven Wertes hinsichtlich kardiovaskulärer Ereignisse.

Summary

Background

The widely used MDRD formula underestimates kidney function in obese patients with diabetes mellitus. Therefore we aimed to evaluate the predictive value of estimated glomerular filtration rate (eGFR) for cardiovascular events in a typical cohort of patients with diabetes mellitus.

Methods

A total of 988 patients were analyzed. Cox regression models including the variables HbA1c, age, duration of diabetes, eGFR and urinary albumin to creatinine ratio (UACR) were run. First the whole collective was analyzed, in a second step the cohort was split into four different groups according to body mass index (BMI) and eGFR (Group 1, 475 Pts: eGFR > 60 ml/min; BMI < 30 kg/m2, Group 2, 274 Pts: eGFR > 60 ml/min;BMI > 30 kg/m2, Group 3, 110 Pts,: eGFR < 60 ml/min; BMI > 30 kg/m2 and Group 4, 129 Pts.: eGFR < 60 ml/min;BMI < 30 kg/m2). eGFR was calculated using MDRD, Cockroft–Gault, and CKD-EPI formula. The endpoint was defined as unplanned cardiovascular hospitalization.

Results

Patients (571 male, 417 female) were 61 ± 22 years of age, mean duration of diabetes was 14.3 ± 12.3 years. After a median follow-up of 29 months 95 (9.6 %) patients reached the defined endpoint. The first model, including all patients showed that UACR (HR 1.001, p < 0.001) and eGFR (HR 0.957, p < 0.001) were significant predictors of the composite endpoint. In obese patients eGFR completely lost its predictive value for cardiovascular events.

The prevalence of normoalbuminuria in patients with an eGFR below 60 ml/min was 59.4 %.

Conclusion

In obese patients eGFR is not predictive for cardiovascular events.

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Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria

    Michael Resl, Greisa Vila, Roland Kraxner, Anton Luger & Martin Clodi

  2. Department of Internal Medicine II, Division of Cardiology, Medical University Vienna, Vienna, Austria

    Richard Pacher & Martin Hülsmann

  3. Division of Cardio-Thoracic-Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Medicine, Vienna, Austria

    Stephanie Neuhold

  4. Diabetes Outpatients Clinic, Gesundheitszentrum Süd, Vienna, Austria

    Helmut Brath

  5. Karl Landsteiner Institute for Nephrology and Diabetes, Hietzing Hospital Vienna, Vienna, Austria

    Rudolf Prager

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  1. Michael Resl
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  2. Greisa Vila
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  10. Martin Clodi
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Correspondence to Martin Clodi.

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Resl, M., Vila, G., Kraxner, R. et al. Estimated glomerular filtration rate and albuminuria: true predictors of cardiovascular events in obese patients with type 2 diabetes?. Wien Klin Wochenschr 125, 629–633 (2013). https://doi.org/10.1007/s00508-013-0422-3

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  • DOI: https://doi.org/10.1007/s00508-013-0422-3

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