COMMENTARY

Don't Miss Renal Impairment in Diabetes

Renal Impairment Common, and Consequences Are 'Grim'

Per-Henrik Groop, MD, DMSc

Disclosures

October 10, 2013

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Renal Impairment: Common in Diabetes

Hello. My name is Per-Henrik Groop, Professor of Nephrology from the University of Helsinki. I am currently at the European Association for the Study of Diabetes (EASD) Congress in Barcelona, Spain. I have a key message that I want to convey to you today, and that is that renal impairment is very common in patients with type 2 diabetes. The consequences of renal impairment in patients with type 2 diabetes are very grim. As clinicians, that means that we need to take action.

What do I mean by saying that we need to take action? First, let me say a few words on the prevalence of renal impairment. Renal impairment, renal dysfunction, or chronic kidney disease -- there are many names for the same thing. You can screen for increased albumin:creatinine ratio or for kidney function. If you do such screening anywhere in the world, you will find that 40%-50% of patients have albuminuria. That means an increased albumin:creatinine ratio or increased leakage of albumin into the urine.

Second, you will find that 22%-24% will have reduced glomerular filtration rate (GFR) according to the formulas that are freely available on the Web, such as the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI). You also can use the Modification of Diet in Renal Disease (MDRD)-4 formula, but don't use the Cockcroft-Gault formula when you screen for renal impairment. If you use screening instruments, you will find that renal impairment is very common in patients with type 2 diabetes, and that is important for us to know. Many clinicians don't consider renal impairment to be important or they know that it is very common. Every second patient in your clinic might have signs of renal impairment.

I also said that the consequences of renal impairment are grim. If you look at the data again, renal impairment means that the patient runs the risk for cardiovascular events. It means that the patient is at risk for increased or premature mortality. It also means that patients will have a higher risk of ending up on dialysis. Of greatest importance, if renal impairment is superimposed on type 2 diabetes, these patients have double the risk for cardiovascular events or severe hypoglycemia.

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