Clinical utility of estimated glomerular filtration rates in predicting renal risk in a district diabetes population

Aims To determine the utility of estimated glomerular filtration rates (eGFR) in predicting renal risk over and above currently available strategies that incorporate serum creatinine and microalbuminuria in a diabetes population. Methods Cross-sectional study of 4548 diabetic individuals attending a single centre over an 18-month period. Glomerular filtration rates were estimated using the Modification of Diet in Renal Disease (MDRD) equation. Microalbuminuria was measured using spot morning urine for albumin:creatinine ratio (ACR). SPSS was utilized for statistical analysis. Results Of the 4303 subjects with complete data, 373 (9%), 2634 (61%), 1197 (28%) and 99 (2%) individuals, respectively, had eGFR > 90, 90-60, 60-30 and < 30 ml/min per 1.73 m(2), respectively. Of those with clinically meaningful renal disease (eGFR < 60 ml/min per 1.73 m(2)), only 42% and 45%, respectively, were identified as at risk by clinical strategies utilizing serum creatinine and urine ACR individually. Even using the two together, 38% of the patients at risk would still not have been identified, since they had normal values of both. Conclusion Current strategies utilizing serum creatinine and urine ACR are insufficient for the detection of renal disease in diabetes. Clinicians should consider monitoring GFR estimates in addition to assessing blood pressure, serum creatinine and urine albumin excretion in order to assess renal status and risk in adults with diabetes.