¿Es apropiada la aplicación de la nueva ecuación Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) en la población española? / Is the use of the new Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) formula appropriate for the Spanish population?

Introducción Las sociedades estadounidenses de nefrología recomiendan cambiar la ecuación CKD-EPI 2009 por la nueva CKD-EPI 2021, que no incluye el coeficiente de raza, para estimar la tasa de filtrado glomerular (TFGe). Se desconoce cómo podría afectar este cambio a la distribución de la enfermedad renal de la población española predominantemente caucásica. Métodos Se estudiaron dos cohortes de adultos de la provincia de Cádiz, BD-SIDICA (n=264.217 personas) y BD-PANDEMIA (n=64.217), que disponían de mediciones de creatinina plasmática entre 2017 y 2021. Se calcularon los cambios de la TFGe y la consecuente reclasificación en las diferentes categorías de la clasificación KDIGO-2012 al modificar la ecuación CKD-EPI 2009 por la de 2021. Resultados En comparación con la ecuación de 2009, CKD-EPI-21 arrojó una TFGe más alta, con una mediana de 3,8mL/min/1,73m2 (IQR: 2,98-4,48) en BD-SIDICA y de 3,89mL/min/1,73m2 (IQR: 3,05-4,55) en BD-PANDEMIA. Como primera consecuencia, del total de la población, el 15,3% en BD-SIDICA y el 15,1% en BD-PANDEMIA y el 28,1% y el 27,3%, respectivamente, de la población con enfermedad renal (G3-G5), se reclasificó a una categoría de TFGe más alta y ningún sujeto a una más grave. Como segunda consecuencia, la prevalencia de la enfermedad renal disminuyó del 9% al 7,5% en ambas cohortes. Conclusiones Implementar la ecuación CKD-EPI-21 en la población española, predominantemente caucásica, aumentaría la TFGe en una cantidad modesta (mayor en hombres y con mayor edad o TFG) y una proporción importante de la población se clasificaría en una categoría de TFGe superior, con la consiguiente disminución de la prevalencia de la enfermedad renal (AU)

Introduction United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. Methods Two databases of adults from the province of Cádiz, DB-SIDICA (n=264,217) and BD-PANDEMIC (n=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. Results Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR: 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR: 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. Conclusions Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease (AU)

Is the use of the new Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) formula appropriate for the Spanish population?

INTRODUCTION: United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. METHODS: Two databases of adults from the province of Cádiz, DB-SIDICA (N=264,217) and DB-PANDEMIA (N=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO 2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. RESULTS: Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. CONCLUSIONS: Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease.

Concordancia entre las ecuaciones "Chronic Kidney Disease Epidemiological Collaboration" y "Modification of Diet in Renal Disease" con la "Berlin Initiative Study" para estimar la función renal en las personas mayores / Concordance between the equations "Chronic Kidney Disease Epidemiological Collaboration" and "Modification of Diet in Renal Disease" with the "Berlin Initiative Study" to estimate renal function in the elderly

OBJETIVO: El filtrado glomerular estimado (FGe) se determina de forma cotidiana mediante fórmulas basadas en creatinina, pero su fiabilidad en personas mayores es limitada. El objetivo fue analizar la concordancia entre la ecuación BIS1, específica del anciano, y las habituales CKD-EPI y MDRD-IDMS, en una amplia población mayor de 70 años. MATERIAL Y MÉTODOS: Estudio transversal retrospectivo. Se calculó FGe por BIS1, CKD-EPI y MDRD-IDMS a partir de datos de sexo, edad y creatinina en 85.089 personas (58,5% mujeres, mediana edad 78 años [RIC 73-83]). Se realizan: test de Wilcoxon, análisis gráfico de Bland-Altman, estudio de la concordancia con el coeficiente de correlación intraclase y tablas comparativas para la clasificación de ERC. RESULTADOS: Las medianas de FGe fueron por BIS1 58mL/min/1,73m2 (RIC 48-70), por CKD-EPI 68mL/min/1,73m2 (RIC 53-84) y por MDRD-IDMS 68mL/min/1,73m2 (RIC 53-82). Se encontró una aceptable concordancia entre BIS1 y CKD-EPI (coeficiente de correlación intraclase =0,87), menor con MDRD-IDMS (coeficiente de correlación intraclase =0,81) y una diferencia media de BIS1 vs. CKD-EPI de 8mL/min/1,73m2 (DE 2,6-18) y de BIS1 vs. MDRD-IDMS de 10mL/min/1,73m2 (DE 6-27), mantenida al estratificar por sexos y grupos de edad. CONCLUSIONES: A pesar del aceptable acuerdo estadístico, el FGe obtenido con la ecuación BIS1 no es intercambiable ni con CKD-EPI ni con MDRD-IDMS. La ecuación BIS1 presenta valores más bajos que CKD-EPI y clasifica en un estadio mayor de ERC a los pacientes, principalmente, cuando FGe está por encima de 30mL/min/1,73m2

OBJECTIVE: Estimated glomerular filtration rate (eGFR) is calculated routinely using creatinine-based formulas, but their reliability in the elderly is limited. The aim of this study was to analyse the concordance between the BIS1 equation which is specific for the elderly, and the usual CKD-EPI and MDRD-IDMS in a large population over 70 years of age. MATERIAL AND METHODS: Retrospective cross-sectional study in which the eGFR was calculated using BIS1, CKD-EPI and MDRD-IDMS equations based on gender, age, and creatinine data of 85,089 subjects (58.5% women, mean age 78 years [IQR 73-83]). The following statistics were carried out: Wilcoxon test, Bland-Altman graphic analysis, study of the concordance using the intraclass correlation coefficient (ICC), and comparison tables for the classification of CKD. RESULTS: The median of the eGFRs using BIS1 was 58mL/min/1.73m2 (IQR 48-70), using CKD-EPI was 68mL/min/1.73m2 (IQR 53-84), and using MDRD it was 68mL/min/1.73m2 (IQR 53-82). The concordance between BIS1 and CKD-EPI (intraclass correlation coefficient =0.87) was found to be acceptable. It was lower with MDRD (intraclass correlation coefficient =0.81). A mean difference of 8mL/min/1.73m2 (SD 2.6-18) was found BIS1 vs. CKD-EPI, and 10mL/min/1.73m2 (SD 6-27) with BIS1 vs. MDRD, which was maintained when stratifying by gender and age groups. CONCLUSIONS: Despite the acceptable statistical agreement, the eGFR obtained with the BIS1 equation is not interchangeable with CKD-EPI or with MDRD-IDMS. The BIS1 equation gives lower values than CKD-EPI, and classifies patients into a higher level of CKD, mainly when the eGFR is above 30mL/min/1.73 m2

[Concordance between the equations "Chronic Kidney Disease Epidemiological Collaboration" and "Modification of Diet in Renal Disease" with the "Berlin Initiative Study" to estimate renal function in the elderly]. / Concordancia entre las ecuaciones «Chronic Kidney Disease Epidemiological Collaboration¼ y «Modification of Diet in Renal Disease¼ con la «Berlin Initiative Study¼ para estimar la función renal en las personas mayores.

OBJECTIVE: Estimated glomerular filtration rate (eGFR) is calculated routinely using creatinine-based formulas, but their reliability in the elderly is limited. The aim of this study was to analyse the concordance between the BIS1 equation which is specific for the elderly, and the usual CKD-EPI and MDRD-IDMS in a large population over 70 years of age. MATERIAL AND METHODS: Retrospective cross-sectional study in which the eGFR was calculated using BIS1, CKD-EPI and MDRD-IDMS equations based on gender, age, and creatinine data of 85,089 subjects (58.5% women, mean age 78 years [IQR 73-83]).The following statistics were carried out: Wilcoxon test, Bland-Altman graphic analysis, study of the concordance using the intraclass correlation coefficient (ICC), and comparison tables for the classification of CKD. RESULTS: The median of the eGFRs using BIS1 was 58mL/min/1.73m2 (IQR 48-70), using CKD-EPI was 68mL/min/1.73m2 (IQR 53-84), and using MDRD it was 68mL/min/1.73m2 (IQR 53-82). The concordance between BIS1 and CKD-EPI (intraclass correlation coefficient =0.87) was found to be acceptable. It was lower with MDRD (intraclass correlation coefficient =0.81). A mean difference of 8mL/min/1.73m2 (SD 2.6-18) was found BIS1 vs. CKD-EPI, and 10mL/min/1.73m2 (SD 6-27) with BIS1 vs. MDRD, which was maintained when stratifying by gender and age groups. CONCLUSIONS: Despite the acceptable statistical agreement, the eGFR obtained with the BIS1 equation is not interchangeable with CKD-EPI or with MDRD-IDMS. The BIS1 equation gives lower values than CKD-EPI, and classifies patients into a higher level of CKD, mainly when the eGFR is above 30mL/min/1.73 m2.

Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional / Prevalence of diabetes, use of antidiabetic drugs and degree of glycaemic control in the province of Cadiz (2014-2016): A population-based study

Antecedentes y objetivo: Los objetivos de este estudio fueron evaluar la prevalencia de diabetes mellitus tratada farmacológicamente, analizar los patrones de prescripción de los fármacos antidiabéticos y evaluar el grado de control de la enfermedad en la provincia de Cádiz. Pacientes y métodos: Estudio observacional retrospectivo utilizando las bases de datos del Sistema Público de Salud del Servicio Andaluz de Salud entre los años 2014 a 2016, ambos inclusive. Se consideró persona adulta con diabetes tratada (PADT) aquella persona mayor de 14 años que había consumido al menos un envase de medicación del grupo A10 a lo largo de cada uno de los años correspondientes de estudio. Resultados: La prevalencia de PADT varió entre el 8,65% y el 8,83% de 2014 a 2016, respectivamente. Un 71% de PADT estaban tratadas solo con fármacos no insulínicos, un 11% con insulinas y un 18% con una combinación de ambos. En aproximadamente un tercio de las PADT no se había realizado una determinación de HbA1c a lo largo de cada año. El 69% de las PADT evaluadas tenía en 2016 un adecuado grado de control de acuerdo a los criterios de la RedGDPS (según HbA1c y edad). Conclusión: La prevalencia de diabetes tratada farmacológicamente en la provincia de Cádiz es elevada y parece ir en aumento. Los pacientes presentan un limitado control glucémico, al que puede contribuir de forma predominante el seguimiento inadecuado en casi una tercera parte de los mismos

Background and objective: The aim of the study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyse the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz. Patients and methods: An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during the corresponding year covered by the study. Results: The prevalence of ATD varied between 8.65% and 8.83% from 2014 to 2016, respectively. Seventy-one percent of the ATD were treated with only noninsulin drugs, 11% were treated with insulin, and 18% were treated with a combination of both. For approximately one-third of the ATD, an HbA1c reading was not performed during each year. Sixty-nine percent of the assessed ATD in 2016 had an appropriate degree of control according to RedGDPS criteria (based on HbA1c and age). Conclusion: The prevalence of pharmacologically treated diabetes in the province of Cadiz is high and appears to be increasing. The patients presented limited glycaemic control, to which inadequate follow-up in almost a third of the patients could be the major contributor

Prevalence of diabetes, use of antidiabetic drugs and degree of glycaemic control in the province of Cadiz (2014-2016): A population-based study. / Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional.

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyse the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz. PATIENTS AND METHODS: An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during the corresponding year covered by the study. RESULTS: The prevalence of ATD varied between 8.65% and 8.83% from 2014 to 2016, respectively. Seventy-one percent of the ATD were treated with only noninsulin drugs, 11% were treated with insulin, and 18% were treated with a combination of both. For approximately one-third of the ATD, an HbA1c reading was not performed during each year. Sixty-nine percent of the assessed ATD in 2016 had an appropriate degree of control according to RedGDPS criteria (based on HbA1c and age). CONCLUSION: The prevalence of pharmacologically treated diabetes in the province of Cadiz is high and appears to be increasing. The patients presented limited glycaemic control, to which inadequate follow-up in almost a third of the patients could be the major contributor.