DIABETIC KIDNEY DISEASE IN CHILDREN: EVALUATION OF GFR

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Relevance.
According to the data of the State Register of Patients with Diabetes Mellitus, as of January 1, 2014, 3,964,889 patients were registered in Russia. The number of sick children was 30,411[3]. In patients with diabetes mellitus, the risk of developing nephropathy increases by 12-15 times. According to the Federal Register of Diabetes Mellitus (DM), 23% of patients with type 1 diabetes have chronic kidney disease (CKD), 13% of them need renal replacement therapy. The main criterion of CKD determining its stages is a decrease in the glomerular filtration rate (GFR)[4]. Currently, various formulas are used to calculate the GFR. Therefore, the search for the most accurate of them is highly relevant.[5]
Objective: to conduct a comparative assessment of various formulas for determining GFR in children with type 1 diabetes.
Materials and methods.
1. Research plan: a retrospective analysis of the case histories of patients undergoing inpatient treatment at the endocrinology department of the Voronezh Regional Children's Clinical Hospital No. 1 with the main diagnosis of type 1 diabetes mellitus (ICD-X: E10).
2. Inclusion criteria: the presence of a diagnosis of "Type 1 diabetes mellitus" in the medical record of an inpatient patient.
3. Conditions of the study: the study was performed at the Department of Hospital Pediatrics of the Voronezh State Medical University named after N.N. Burdenko. The base was the BUZ IN VODKB No. 1.
4. The study and structuring of the materials were carried out in the period from July 2021 to February 2022.
5. Description of medical intervention: the object of the study was the case histories of 51 patients aged 6 to 17 years, including 34 (65.4%) boys and 18 (34.6%) girls. During the analysis, the serum creatinine level was studied, followed by an assessment of the GFR level using various formulas.
6. The main outcome of the study: determination of GFR by various formulas in children with type 1 diabetes mellitus.
7. Additional study outcomes: Additional study outcomes have not been studied.
8. The GFR analysis was carried out in the general group of children with type 1 diabetes mellitus, as well as in a sample with diabetes experience up to 2 years, more than 2 to 5 years; over 5 years.
9. Methods of registering outcomes: to calculate GFR, formulas were used in which data on gender, age, height, and serum creatinine were entered.
10. Statistical analysis: Microsoft Excel 2011 was used to register the results of the study. Data was entered based on patient medical histories.
Results.
51 medical histories of children diagnosed with type 1 diabetes mellitus were analyzed. Among them, 34 (67.7%) boys and 17 (33.3%) girls aged 6 to 17 years. Of these, 15 children (29.4%) with diabetes experience under 2 years, 22 (43.2%) children from 2 to 5 years, and 14 (27.4%) children over 5 years old.
In the studied general group, the following GFR indicators were revealed: according to the Schwartz formula of 1976 (126.76 ± 16.37 ml/min/1.73 m2), according to the Schwartz-Lyon formula (83.39 ± 10.59 ml/min/1.73 m2), according to the Schwartz formula "bedside" (89.95 ± 11.82 ml/min/1.73 m2), according to the Qvr formula (age-dependent) (89.81 ± 14.95 ml /min/ 1,73m2), according to the formula Growth (growth-dependent) (92.71 ± 13.53 ml/min/ 1.73 m2), according to the formula Lund-Malmo revised (92.48 ± 10.1 ml/min/ 1.73 m2), according to the formula of the European Consortium (EKFC) (87.03 ± 14.58 ml/min/ 1.73 m2).
The analysis in the diabetes experience subgroups showed the following result:
With an experience of diabetes up to 2 years , the GFR indicators were:
According to the Schwartz formula of 1976 (123.96 ± 15.9 ml/min/1.73 m2), according to the Schwartz-Lyon formula (84.21 ± 11.6 ml/min/1.73 m2), according to the Schwartz formula "bedside" (91.64 ± 12.21 ml/min/1.73 m2), according to the Qvr (age-dependent) formula (86.17 ± 12.94 ml/min/ 1.73 m2), according to the Qrost formula (growth-dependent) (90.54 ± 13.44 ml/min/1.73 m2), according to the Lund-Malmo formula revised (92.64 ± 9.53 ml/min/ 1.73 m2), according to the formula of the European Consortium (EKFC) (84.29 ± 15.89 ml/min/1.73 m2).
With diabetes experience from 2 to 5 years: according to the Schwartz formula of 1976 (127.20± 15.97 ml/min/1.73 m2), according to the Schwartz-Lyon formula (82.99± 9.93 ml/min/ 1.73 m2), according to the Schwartz formula "bedside" (89.38± 10.79 ml/min/ 1.73 m2), according to the Qvr formula (age-dependent) (87.96 ± 11.72 ml/ min/ 1,73m2), according to the formula Growth (growth-dependent) (93.64± 14.13 ml/min / 1.73 m2), according to the formula Lund-Malmo revised (91.10± 9.48 ml/min/ 1.73 m2), according to the formula of the European Consortium (EKFC) (85.79 ± 12.95 ml/min / 1.73 m2).
With an experience of diabetes from 5 years: according to the Schwartz formula of 1976 (129.06± 18.2 ml/min/ 1.73 m2), according to the Schwartz-Lyon formula (83.14± 11.23 ml/min/ 1.73 m2), according to the Schwartz formula "bedside" (89.06± 13.56 ml/min/1.73 m2), according to the Qvr formula (age-dependent) (96.61± 19.65 ml/min/1, 73m2), according to the formula Q Growth (growth-dependent) (93.57± 13.4 ml /min / 1.73 m2), according to the formula Lund-Malmo revised (94.49± 11.91 ml/min / 1.73 m2), according to the formula of the European Consortium (EKFC) (91.91 ± 15.4 ml/min / 1.73 m2).
Based on the above data, we can say that the GFR, according to the Schwartz formula of 1976, turned out to be significantly higher in contrast to other formulas. This applies to the general group of patients, and children with different experience of type 1 diabetes. In children, even with the experience of type 1 diabetes for more than 5 years, there was no decrease in GFR.

Discussion.
Niche studies have shown that in children with type 1 diabetes mellitus, the glomerular filtration rate calculated using the Schwartz formula of 1976 is not reliable, since it overestimates the results (p<0.05), in comparison with the GFR calculated using other formulas. According to the correlation analysis, the greatest relationship with serum creatinine has GFR indicators calculated according to the formula "Schwartz "bedside"" (-0.707).
This formula should be used to calculate the GFR, but further research of alternative formulas is required. The search for the most accurate calculation of GFR will optimize the diagnosis of diabetic kidney disease in children. In the cohort of children examined by us, there was no decrease in GFR, even with an experience of type 1 diabetes for more than 5 years.
Conclusion.
According to the study, differences in GFR indicators calculated by various formulas were established. This applies more to the Schwartz formula of 1976. This formula overestimates the results of GFR (p<0.05). The maximum correlation was established between serum creatinine and GFR calculated according to the formula "Schwartz "bedside"" (-0.707). The revealed results among the studied patients indicate the continuation of the search for the most optimal assessment of GFR in type 1 diabetes in children.

About the authors

Аlexander R. Matykin

Author for correspondence.
Email: mat_28@mail.ru
ORCID iD: 0000-0002-8477-5908
SPIN-code: 5136-7123
Russian Federation

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