Glycaemic changes in patients with chronic kidney disease

• Published in: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 36; no. 2; p. 133
• Main Authors: De'Marziani, Guillermo, Soler Pujol, Gervasio, Obregón, Liliana Miriam, Morales, Elisa Mabel, Gonzalez, Claudio Daniel, Gonzalez Paganti, Luciana, Cacciagiú, Leonardo, Lopez, Graciela, Schreier, Laura, Elbert, Alicia
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 2016
• Subjects: Adult; Aged; Argentina; Blood Glucose; Glucose Intolerance; Glucose Tolerance Test; Humans; Male; Middle Aged; Renal Insufficiency, Chronic - metabolism; Oral glucose tolerance test; Impaired fasting glucose; Trasplante; Chronic kidney disease; Transplantation; Haemodialysis; Tolerancia alterada a la glucosa; Glucemia alterada en ayunas; Enfermedad renal crónica; Prueba de tolerancia oral a la glucosa; Hemodiálisis; Diabetes; Impaired glucose tolerance
• ISSN: 1989-2284
• DOI: 10.1016/j.nefro.2015.10.011

In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality.