Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Dec 25, 2024; 13(4): 95761
Published online Dec 25, 2024. doi: 10.5527/wjn.v13.i4.95761
Detection of decline in estimated glomerular filtration rate in patients with type 2 diabetes by cystatin C-based equations
Tam Thai Thanh Tran, Tien Kim Ha, Nhut Minh Phan, Minh Van Le, Tin Hoang Nguyen
Tam Thai Thanh Tran, Tin Hoang Nguyen, Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Viet Nam
Tam Thai Thanh Tran, Tin Hoang Nguyen, Department of Functional Exploration, Can Tho University of Medicine and Pharmacy Hospital, Can Tho 900000, Viet Nam
Tien Kim Ha, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 550000, Viet Nam
Nhut Minh Phan, Minh Van Le, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Viet Nam
Co-first authors: Tam Thai Thanh Tran and Tien Kim Ha.
Co-corresponding authors: Minh Van Le and Tin Hoang Nguyen.
Author contributions: Tran TTT, Phan NM and Ha TK designed the study; Ha TK and Tran TTT performed the study; Nguyen TH, Phan NM and Ha TK contributed new reagents and analytic tools; Le MV, Tran TTT, Nguyen TH and Phan NM analyzed the data and wrote the manuscript. All authors have read and approved the final manuscript. Tran TTT and Ha TK contributed equally to this work as co-first authors. The designation of two individuals as corresponding authors for this article is important for several reasons. Firstly, it is important that these two individuals are recognized for their equal contributions and leadership in coordinating the research and writing the manuscript. Secondly, it also reflects their collaborative efforts in preparing the necessary documents required by the journal’s editorial board. By sharing this title, both authors can represent the work equally in conferences and the scientific community, ensuring that credit is appropriately distributed. Furthermore, it promotes an inclusive academic environment that encourages teamwork and recognizes the diverse skills that each author brings. This approach can enhance the visibility of the research and promote further collaboration on future projects. In summary, the designation of two corresponding authors is appropriate to the actual roles and responsibilities assigned to the authors.
Institutional review board statement: The research was conducted in compliance with approval from Can Tho University of Medicine and Pharmacy in Viet Nam by an approval document (No. 876/QĐ-ĐHYDCT, 2020, May 29th).
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The corresponding author may share any data from the study upon reasonable request to nhtin@ctump.edu.vn.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tin Hoang Nguyen, BMed, MSc, Doctor, Lecturer, Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, No. 179 Nguyen Van Cu Street, An Khanh Ward, Ninh Kieu District, Can Tho 900000, Viet Nam. nhtin@ctump.edu.vn
Received: April 17, 2024
Revised: September 15, 2024
Accepted: October 15, 2024
Published online: December 25, 2024
Processing time: 203 Days and 15.7 Hours
Abstract
BACKGROUND

Aging population is a significant issue in Viet Nam and across the globe. Elderly individuals are at higher risk of chronic kidney disease (CKD), especially those with diabetes. Several studies found that the estimated glomerular filtration rate (eGFR) determined using creatinine-based equations was not as accurate as that determined using cystatin C-based equations. Cystatin C-based equations may be beneficial in elderly patients with an age-associated decline in kidney function. Early determination of eGFR decline and associated factors would aid in appropriate interventions to improve kidney function in elderly patients with diabetes.

AIM

To determine the utility of cystatin C-based equations in early detection of eGFR decline and to explore factors associated with eGFR decline in elderly patients with diabetes.

METHODS

This cross-sectional study included 93 participants aged ≥ 60 years evaluated in Can Tho University of Medicine and Pharmacy Hospital between October 2022 and July 2023, including 47 and 46 participants with and without diabetes respectively, according to the American Diabetes Association criteria for diabetes. The kappa coefficient, Student’s t, Mann-Whitney, χ2, Pearson’s correlation, multivariate logistic regression, and multiple linear regression analyses were employed.

RESULTS

The eGFRs were lower with the cystatin C-based equations than with the creatinine-based equations. Good agreement was found between the Modification of Diet in Renal Disease (MDRD) and CKD Epidemiology Collaboration (CKD-EPI) 2021 creatinine-cystatin C equations (kappa = 0.66). In the diabetes group, 30% of the participants had low eGFR. Both plasma glucose and glycated hemoglobin were associated with an increased risk of eGFR decline (P < 0.05) and negatively correlated with eGFR (P = 0.001). By multivariate logistic regression, total cholesterol, and exercise were independently associated with low eGFR. By multiple linear regression, higher plasma glucose levels were correlated with lower eGFR (P = 0.026, r = -0.366).

CONCLUSION

Cystatin C-based equations were superior in the early detection of a decline in eGFR, and the MDRD equation may be considered as an alternative to the CKD-EPI 2021 creatinine-cystatin C equation. Exercise, plasma glucose, and total cholesterol were independently associated with eGFR in patients with diabetes.

Keywords: Cystatin C; Estimated glomerular filtration rate; Elderly; Diabetes; Nephrology; Kidney function

Core Tip: Early detection of decline in kidney function in elderly patients, which can be achieved with cystatin C-based equations, can allow treatment adjustments tailored to the patient’s renal condition. In cases where serum cystatin C cannot be determined, the Modification of Diet in the Renal Disease equation, which exhibits good agreement with the cystatin C-based equations, can be considered. Based on our multivariate analysis, regulating blood glucose and total cholesterol levels, and implementing regular exercise might significantly impact the estimated glomerular filtration rate in elderly patients with type 2 diabetes.