Original Title: Complicaciones de la diabetes. Nefropatía diabética

Authors' objectives: To conduct a review of the current scientifi c evidence available regarding DN screening, in order to facilitate evidence based decision making to develop DN screening programmes. The questions to be answered are the following: what is the most appropriate test for DN screening?, when should DN screening start in relation to the diabetes diagnosis?, how often should DN screening be performed?

Authors' results and conclusions: The studies recovered from the search include a meta-analysis, 2 systematic reviews, 6 CPG, 6 reviews and one original article about diagnostics test among others. Neither, clinical trials that looked into screening impact evaluation, nor assessments about different screening methods in the diabetic patients’ clinical evolution, were identified. There is consensus about recommending DN screening. Most studies recommend two components to be included in DN screening. Being MA determination, the fi rst of these two components, to identify renal damage. Most advocate for the albumin/creatinine ratio, with laboratory methods, preferably in fi rst morning urine or in a random urine sample, being essential also to rule out other possible causes for MA. The second component of the screening programme is the estimation of the renal function. With serum creatinine determination and through some equations, the glomerular fi ltration rate can be estimated. These equations present numerous biases, and provide worse estimations in the diabetic patient, despite of it, they have been considered to be the best alternative. Regarding the moment when DN screening should start, several guidelines based on consensus agree in performing an annual test, 5 years after the diagnosis of DM in DM 1 patients and at the moment of the diagnosis in all DM 2 patients, in order to detect MA. Regarding the frequency of the screening, it is recommended by consensus to screen annually in DM 1 and DM 2 patients. To detect DN, is necessary to identify in diabetic patients, the beginning of renal damage and the loss of renal function, through microalbuminuria determination and glomerular fi ltration rate estimation, respectively. Most CPG, recommend the determination of the albumin/creatinine ratio through laboratory methods, preferably in fi rst morning urine or in a random urine sample, for the screening of MA. Regarding the estimation of the renal function which is the second component of the screening programme, nearly all studies recommend performing in all diabetic adult patients, serum creatinine determination at least once a year, to estimate the glomerular filtration rate and to establish the chronic kidney disease staging, regardless of the urine albumin excretion. The degree of evidence is based on consensus. It is recommended by consensus, to start DN screening 5 years after the diagnosis of DM in DM 1 patients, and from the moment of the diagnosis in DM 2 patients. An annual follow-up is recommended by consensus, for both MA determination and glomerular filtration rate estimation. It is highlighted the need to perform primary studies, to develop specific evaluations of the different screening methods and their impact in the clinical evolution of the diabetic patients, to reinforce the previous conclusions.

Authors' methods: A document review from January 2004 to September 2008 in main biomedical databases: Medline, Embase, NHS Centers for Review and Dissemination, Cochrane Library Plus, IME, IBECS, LILACS, Trip Database; and in offi cial websites from different clinical practice guidelines (CPG) developers and National and International Health Technology Assessment Agencies. Articles were selected according to inclusion and exclusion criteria related to study design, study population, intervention, outcomes and language.

Project Status: Completed

Year Published: 2009

URL for published report: https://www.iacs.es/wp-content/uploads/2017/04/281_Nefropat%C3%ADa_diabetes_IACS.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Health Sciences Institute in Aragon (IACS)

Contact Address: Avda, San Juan Bosco, 13, planta 2

Contact Name: María Pilar Calvo Pérez

Contact Email: direccion.iacs@aragon.es