Change of renal function after short-term use of cardioprotective agents in patients with type 2 diabetes is not accurately assessed by the change of estimated glomerular filtration rate: an observational study

Julie Kolwelter; Kristina Striepe; Agnes Bosch; Dennis Kannenkeril; Christian Ott; Mario Schiffer; Roland E Schmieder

doi:10.1186/s13098-022-00874-1

Change of renal function after short-term use of cardioprotective agents in patients with type 2 diabetes is not accurately assessed by the change of estimated glomerular filtration rate: an observational study

Diabetol Metab Syndr. 2022 Jul 21;14(1):102. doi: 10.1186/s13098-022-00874-1.

Authors

Julie Kolwelter^{1

2}, Kristina Striepe¹, Agnes Bosch¹, Dennis Kannenkeril¹, Christian Ott^{1

3}, Mario Schiffer¹, Roland E Schmieder⁴

Affiliations

¹ Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
² Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
³ Department of Nephrology and Hypertension, Paracelsus Medical School, Nuremberg, Germany.
⁴ Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany. Roland.Schmieder@uk-erlangen.de.

Abstract

Background: After initiating cardioprotective agents, a fall of estimated glomerular filtration rate (eGFR) has been reported in several studies. Our goal was to evaluate the accuracy of change of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR in patients with type 2 diabetes (T2D) after short-term pharmacological intervention with angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, gliptin or sodium-glucose cotransporter-2 inhibitor.

Methods: We analyzed 190 patients with T2D in the early stage of the disease, having no overt renal impairment by CKD-EPI equation. In each patient, we measured GFR (mGFR) by applying the constant infusion input clearance technique with sinistrin (Inutest; Fresenius, Linz, Austria) at baseline and after short-term (4-12 weeks) pharmacological intervention with cardioprotective agents (ramipril, telmisartan, linagliptin, metformin, empagliflozin) that potentially lead to an alteration of renal function. Simultaneously, a standardized analysis of serum creatinine was performed and eGFR was estimated by the CKD-EPI equation.

Results: Average mGFR was 111 ± 20 ml/min/1.73m², whereas eGFR was lower with 93 ± 13 ml/min/1.73m². The ratio eGFR/mGFR in relation to mGFR was almost curvilinear, showing an underestimation of renal function by eGFR in the upper normal range. At baseline only 80 patients (42%) lay within ± 10% of mGFR and the concordance correlation coefficient (CCC) was extremely low (- 0.07). After short-term pharmacological intervention changes in eGFR and mGFR correlated with each other (r = 0.286, p < 0.001). For example, for a given mGFR of 111 ml/min/1.73m², a change of mGFR by ± 10% corresponded to ± 11 ml/min/1.73m², but the confidence interval of eGFR was 25 ml/min/1.73m². The CCC was low (0.22).

Conclusion: The agreement between eGFR by CKD-EPI and mGFR is modest and the change of renal function after short-term pharmacological intervention is not accurately and precisely reflected by the change of eGFR in patients with T2D in the early stage of their disease.

Keywords: Change of renal function; Glomerular filtration rate; Inulin clearance; Type 2 diabetes.