Abstract
Objetivo
Determinar la prevalencia de insuficiencia renal en diabéticos tipo 2 y comparar dos criterios de definición: el basado en la estimación del filtrado glomerular por la fórmula de Cockcroft-Gault corregida para la superficie corporal y el basado en la creatinina sérica.
Diseño
Estudio descriptivo y transversal.
Emplazamiento
Zona básica del Centro de Salud de El Cristo, Oviedo.
Participantes
La totalidad de pacientes diabéticos tipo 2 diagnosticados de la zona básica.
Mediciones principales
Se recogieron datos demográficos, clínicos, factores de riesgo y enfermedad cardiovascular. Se diagnosticó insuficiencia renal (IR) según unas cifras de creatinina plasmática ≥ 1,3 mg/dl en mujeres y ≥ 1,4 mg/dl en varones y según el filtrado glomerular (FG) estimado mediante la fórmula de Cockcroft-Gault: moderada para FG, 60-30 ml/min/1,73 m2; grave para FG, 29-15 ml/min/1,73 m2, y terminal para FG, < 15 ml/min/1,73 m2.
Resultados
Se incluyó a 499 pacientes. El 52,3% era mujer con una edad de 69,7 ± 0,4 años. La prevalencia de IR según la creatinina sérica fue del 12%, y según la fórmula de Cockcroft-Gault del 40,5%. Los pacientes con FG reducido y creatinina normal tenían mayor edad (75,5 ± 7,9 frente a 65,4 ± 9,8 años; p < 0,001), predominaban las mujeres (76,3 frente a 41,7%; p < 0,001), tenían un menor índice de masa corporal (27,3 ± 3,7 frente a 30,9 ± 4,4), presentaban un peor control glucémico (HbA1c 7,1 ± 1,8 frente a 6,9 ± 1,9%; p = 0,007) y la prevalencia de insuficiencia cardíaca era superior (6,4 frente a 2,1%; IC del 95%, 1,1-8,8; p = 0,02) en comparación con los pacientes con FG y creatinina normales.
Conclusión
La estimación del FG por la fórmula de Cockcroft-Gault corregida para la superficie corporal muestra una insuficiencia renal no conocida en uno de cada 3 pacientes diabéticos tipo 2.
Palabras clave: Insuficiencia renal, Diabetes tipo 2, Fórmula de Cockroft-Gault
Abstract
Objective
To determine the prevalence of renal failure (RF) in type-2 diabetics and to compare two criteria of definition: that based on the calculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area and that based on serous creatinine.
Design
Cross-sectional, descriptive study.
Setting
El Cristo Health Centre,Oviedo, north of Spain.
Participants
All patients in the catchment area diagnosed with type-2 diabetes.
Method
Demographic, clinical, risk factor, and cardiovascular pathology details were gathered. Renal failure was diagnosed on figures of plasma creatinine ≥1.3 mg/dL in women and ≥1.4 mg/dL in men, and glomerular filtration (GF) calculated by means of the Cockcroft-Gault formula: moderate GF, 60-30 mL/min/1.73 m2; severe GF, 29-15 mL/min/1.73 m2, and terminal GF: <15 mL/min/1.73 m2.
Results
499 patients were included. 52.3% were women, aged 69.7±10.4 years old. Prevalence of RF by serous creatinine was 12%; and by the Cockcroft-Gault formula, 40.5%. Patients with lower glomerular filtration and normal creatinine were older (75.5±7.9 vs 65.4±9.8; P<.001), mainly female (76.3% vs 41.7%; P<.001), had lower BMI (27.3±3.7 vs 30.9±4.4) and had worse glucaemia control (HbA1c 7.1±1.8% vs 6.9±1.9%; P=.007) and higher indices of cardiac failure (6.4% vs 2.1%; 95% CI, 1.1- 8.8; P=.02) than patients with normal glomerular filtration and creatinine.
Conclusion
Calculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area revealed unknown renal failure in 1 in 3 type-2 diabetes patients.
Key words: Renal failure, Type-2 diabetes, Cockcroft-Gault formula
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