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A relatively minor degree of renal impairment can indicate substantially raised cardiovascular risk in people with type 2 diabetes, according to a study reported at the European Association for the Study of Disease (EASD) 42nd Annual Meeting, held September 14–17 in Copenhagen, Denmark.
Researchers analyzing data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial found that a modest reduction in estimated glomerular filtration rate (eGFR) can signal nearly doubled risk of cardiovascular events such as heart attack or stroke. FIELD investigator Paul L. Drury, MD, of the Auckland Diabetes Centre in New Zealand, presented the data.
One of the largest intervention studies ever conducted for the prevention of cardiovascular disease in people with diabetes, FIELD examined the effect of fenofibrate on 9,795 people with type 2 diabetes and mild dyslipidemia followed for 5 years at 63 medical centers in Australia, New Zealand, and Finland.1
To look at kidney impairment, investigators studied about 4,900 people in
the placebo group of the FIELD study in order to eliminate the effects of
fenofibrate. Estimated glomerular filtration rate was derived by two different
methods, with the results grouped into tertiles of <60 ml/min, 60–90
ml/min, and 
90 ml/min.
The Cockroft-Gault formula is a commonly used marker for creatinine clearance that uses a blood measurement of plasma creatinine in milligrams per deciliter and is factored with the patient's sex, body weight (in kilograms), and age to arrive at an estimated rate.2 The Modification of Diet in Renal Disease (MDRD) formula, established in 1999, multiplies creatinine levels by the patient's age, a factor for race, and a numerical constant.3 Some versions of the MDRD formula include albumin and blood urea nitrogen. In its Standards of Medical Care in Diabetes—2006, the American Diabetes Association notes that GFR can be easily estimated using formulas like Cockroft-Gault or the one derived from the MDRD study.4
Depending on which method of measuring eGFR was used, the risk of
cardiovascular events was 180% to almost 400% greater among people with a rate
<60 ml/min, and 33–75% greater for people with a rate of 60–90
ml/min, compared with those with a rate 90 ml/min.
Estimation of glomerular filtration rate, especially by the MDRD method,
may be a simpler and more consistent method of assessing risk and improved
cardioprotective therapy than measurement of blood pressure or proteinuria in
people with diabetes, the investigators conclude. 
Footnotes
Cockroft-Gault and MDRD calculators for eGFR are available online from the National Kidney Foundation at www.kidney.org/professionals/kdoqi/gfr_calculator.cfm.
References
2. Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41, 1976.[Medline]
3. Levey AS, Bosch JP, Lewis JB, et al., for the Modification of Diet
in Renal Disease Study Group: A more accurate method to estimate glomerular
filtration rate from serum creatinine: A new prediction equation.
Ann Intern Med 130:461–470, 1999.
4. American Diabetes Association: Standards of medical care in
diabetes—2006 (Position Statement). Diabetes
Care 29 (Suppl. 1):S4
–S42, 2006.
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