Renal function decrement in type 2 diabetes mellitus patients in Cipto Mangunkusumo Hospital

to screen for reduction of renal function in type 2 diabetes mellitus (DM) patients based on various estimated Glomerular Filtration rate (eGFR).

1283 newly registered type 2 DM patients were included in the study room from the year 2003 until 2006. We calculated the eGFR by the Cockroft-Gault (CG), Cockroft-Gault adjusted for body surface area (CG-BSA), 4-variables Modification of Diet in Renal Disease (MDRD), and Chinese adapted MDRD (C-MDRD) methods based on serum creatinine. We also investigated the significant risk factors based on the method with the highest percentage of renal dysfunction.

type 2 DM patients with serum creatinine > or = 2 mg/dL (the abnormal limit in Indonesia) was only 5.8%, but the prevalence of patients with eGFR<60mL/mnt was 36.1% (CG), 43.7% (CG-BSA), 13.2% (MDRD), or 22.8% (C-MDRD). We used CG-BSA to determine risk factors as the highest method with highest percentage of renal dysfunction. Significant risk factors for renal dysfunction based on multivariate analysis were history of hypertension (P=0.025, 95%Cl 1.08-3.19), proteinuria (P=0.015, 95%Cl 1.13-3.22), and diabetic retinopathy (P=0.001, 95% Cl 1.43-4.20).

the use of eGFR is recommended to screen in type 2 DM patients than the use of mere serum creatinine. We advocate the use of CG-BSA method to increase the physician's awareness, as more subjects will fall within the ambit of CKD.