埃塞俄比亚南部一家医院就诊的糖尿病患者中的慢性肾脏病及肾功能不全漏诊情况
Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia.
作者信息
Fiseha Temesgen, Kassim Mehidi, Yemane Tilahun
机构信息
Department of Clinical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
出版信息
BMC Nephrol. 2014 Dec 15;15:198. doi: 10.1186/1471-2369-15-198.
BACKGROUND
Diabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine.
METHODS
A total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine.
RESULTS
CKD, defined as eGFR<60 ml/min/1.73 m2, was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR<60 ml/min/1.73 m2 had abnormal serum creatinine values, i.e. >1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2-3 CKD) despite normal creatinine levels. CKD, eGFR<60 ml/min/1.73 m2, was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively.
CONCLUSION
CKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2-3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.
背景
根据肾小球滤过率（GFR）降低定义的慢性肾脏病（CKD）糖尿病患者发生心血管和肾脏事件及死亡的风险更高。本研究的目的是确定埃塞俄比亚南部一家医院就诊的糖尿病患者中CKD的患病率，并评估血清肌酐正常的患者中肾功能不全的漏诊情况。
方法
2013年9月1日至10月31日期间，共有214名在埃塞俄比亚南部布塔吉拉医院随访门诊随机选取的糖尿病患者参与了本研究。所有患者均完成了由访员管理的问卷调查并接受了临床评估。采用简化的肾脏疾病饮食改良（MDRD）和Cockcroft-Gault（C-G）公式根据血清肌酐估算GFR（eGFR）。
结果
根据MDRD和Cockcroft-Gault（C-G）公式，分别有18.2%和23.8%的研究参与者存在CKD，定义为eGFR<60 ml/min/1.73 m²。在所有参与者中，仅有9.8%的人以及eGFR<60 ml/min/1.73 m²的参与者中有48.7%（MDRD法）和37.3%（C-G法）血清肌酐值异常，即>1.5 mg/dl。在该医院就诊的参与者中，90.2%的人血清肌酐正常。尽管肌酐水平正常，但38.9%-56.5%的很大一部分参与者显示存在轻度至中度肾功能不全（CKD 2-3期）。分别采用MDRD和C-G公式时，血清肌酐正常的参与者中发现CKD（eGFR<60 ml/min/1.73 m²）的比例分别为10.4%和16.9%。
结论
在该医院就诊的糖尿病患者中，CKD的患病率不少于18%，但通常未被诊断出来。相当数量的糖尿病患者尽管肌酐水平正常，但存在相当于CKD 2-3期的肾功能不全。因此，无论血清肌酐水平是否在正常范围内，都应将GFR视为肾功能不全的一项评估指标。
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