Underdiagnosed Chronic Kidney Disease in Diabetic Patients

Abstract

Introduction: Diabetes mellitus is a major cause of chronic kidney
disease, which is often undervalued. The aim of this study was to
determine the prevalence of chronic kidney disease among diabetic
patients type 2, even showing normal serum creatinine.
Material and Methods: A retrospective observational study with a
process of clinical revision and analytical results was conducted,
involving a total of 483 patients who were followed by external medicine
consultation in what concerns diabetes during the year of 2014.
Results: Of the total of patients 60% were women, which mean age
was 65 ± 10.6 years. The studied participants revealed that 31.7%,
according to MDRD4 equation and 28.0%, according to Crockcoft-
Gault equation, suffered from chronic kidney disease (defined as
glomerular filtration rate (GFR) < 60 mL/min/1.73 m2). The distribution
among the different stages was the following by MDRD4 equation:
13.9% in stage, 9.1% in stage 3b, 6.8% in stage 4 and 1.9%
in stage 5. In what concerns the Crockcoft-Gault equation, we had:
11.6%, 7.9%, 4.1% and 1.7% respectively. Only 44.4% and 43.7%
of those with GFR < 60 mL/min /1.73 m2, according to the equations
MDRD4 and GCC presented serum creatinine higher than 1.5
mg/dL, despite only in 58.0% the chronic kidney disease was recognized.
Microalbuminuria was found in 113 patients (23.4%) of which 48
(MDRD4) and 40 (CCG) showed GFR < 60 mL/min /1.73 m2.
Conclusion: This study revealed that chronic kidney disease is underdiagnosed
and that microalbuminuria appears precociously, despite
normal serum creatinine and GFR can be still unchanged. Assessment
of renal function is therefore important, since detecting chronic kidney
disease during its initial stages provides the opportunity for early therapeutic
interventions.