A comparison of change in measured and estimated glomerular filtration rate in patients with nondiabetic kidney disease

Dawei Xie, Marshall M. Joffe, Steven M. Brunelli, Gerald Beck, Glenn M. Chertow, Jeffrey C. Fink, Tom Greene, Chi Yuan Hsu, John W. Kusek, Richard Landis, James Lash, Andrew S. Levey, Andrew O'Conner, Akinlolu Ojo, Mahboob Rahman, Raymond R. Townsend, Hao Wang, Harold I. Feldman

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives: All glomerular filtration rate (GFR) estimating equations have been developed from cross-sectional data. The aims of this study were to examine the concordance between use of measured GFR (mGFR) and estimated GFR (eGFR) in tracking changes in kidney function over time among patients with moderately severe chronic kidney disease. Design, setting, participants, & measurements: A retrospective cohort study of subjects who had been enrolled in the MDRD Study A and who had two or more contemporaneous assessments of mGFR and eGFR (n = 542; mGFR range, 25 to 55 ml/min per 1.73 m2) during the chronic phase (month 4 and afterwards). mGFR was based on urinary iothalamate clearance; eGFR was based on the 4-variable MDRD Study equation. Temporal changes in GFR were assessed by within-subject linear regression of time on GFR. Results: Median follow-up time for all subjects was 2.6 yr; median number of GFR measurements was six. The eGFR slope tended to underestimate measured decrements in GFR. The absolute value of the difference in mGFR and eGFR slopes was ≤2 ml/min per 1.73 m2 per yr among 58.3% of subjects; the remainder of subjects had larger absolute differences. Among the 22 variables studied, none predicted a systematic difference between mGFR slope and eGFR slope. Conclusions: Although eGFR and mGFR exhibited similar relationships to 22 baseline variables, the overall bias seen in the full cohort suggests that clinicians and researchers should exercise caution when interpreting eGFR slope as a marker of progression of kidney disease.

Original languageEnglish (US)
Pages (from-to)1332-1338
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number5
DOIs
StatePublished - Sep 2008
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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