Update on estimation of kidney function in diabetic kidney disease

P Bjornstad, DZ Cherney, DM Maahs - Current diabetes reports, 2015 - Springer
Current diabetes reports, 2015Springer
Abstract The American Diabetes Association recommends annual assessment of glomerular
filtration rate (GFR) to screen for diabetic nephropathy. GFR is measured indirectly using
markers that, ideally, are eliminated only by glomerular filtration. Measured GFR, although
the gold standard, remains cumbersome and expensive. GFR is therefore routinely
estimated using creatinine and/or cystatin C and clinical variables. In pediatrics, the
Schwartz creatinine-based equation is most frequently used even though combined …
Abstract
The American Diabetes Association recommends annual assessment of glomerular filtration rate (GFR) to screen for diabetic nephropathy. GFR is measured indirectly using markers that, ideally, are eliminated only by glomerular filtration. Measured GFR, although the gold standard, remains cumbersome and expensive. GFR is therefore routinely estimated using creatinine and/or cystatin C and clinical variables. In pediatrics, the Schwartz creatinine-based equation is most frequently used even though combined creatinine and cystatin C-based equations demonstrate stronger agreement with measured GFR. In adults, the CKD Epidemiology Collaboration (CKD-EPI) equations with creatinine and/or cystatin C are the most accurate and precise estimating equations. Despite recent advances, current estimates of GFR lack precision and accuracy before chronic kidney disease stage 3 (GFR < 60 mL/min/1.73 m2). There is therefore an urgent need to improve the methods for estimating and measuring GFR. In this review, we examine the current literature and data addressing measurement and estimation of GFR in diabetes.
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