Clinical experience of using the ckd progression rate calculator to stratify a group of elderly patients with type 2 diabetes with a very high risk of cardiovascular outcomes

Objective: to analyze the clinical experience of using the CKD progression rate calculator to stratify the prognosis of elderly patients with DM2, belonging to a very high cardiovascular risk group. Material and methods: to determine the systemic coronary risk of elderly patients with DM2, the generally accepted and most relevant SCORE2 and SCORE2-OP algorithms were used to assess the 10-year risk of fatal and nonfatal cardiovascular events. Further more accurate stratification of the risks of CKD was performed using a prognostic Calculator of the rate of progression of CKD in elderly patients with DM2, developed at the Department of Endocrinology of the Samara state medical university. Results: as a clinical example, two 69 and 70-year-old patients were randomly selected from the group of participants used in the development of the mathematical model of the Calculator. According to the SCORE2 and SCORE2-OP algorithms, both patients were assigned to a very high-risk group of cardiovascular diseases, the values of which were 33% for patient XXX; 24% for patient YYY, excluding concomitant DM2 and CKD. To clarify the clinical prognosis, an original Calculator was used, which demonstrated different characteristics of the CKD progression rate in these patients (“low” and “high” with a cut-off value of the GFR reduction index of 3.83 ml/min/1.73 m2 per year), despite the identity of the parameters of the clinical and laboratory status. Conclusions: the use of traditional ASSR risk assessment scales for predicting outcomes in a cohort of elderly with DM2 has significant limitations, since most patients of older age groups fall into a homogeneous group of very high risk without the possibility of further stratification; the use of a Calculator for the rate of progression of CKD allows you to refine the prognosis, optimize the program of follow-up and determine indications for prescribing drugs with proven nephroprotective the effect in elderly patients with DM2.

old age, diabetes mellitus, prognosis, clinical outcome, chronic kidney disease

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