TY - JOUR
T1 - Reliability of GFR formulas based on serum creatinine, with special reference to the MDRD Study equation
AU - Coresh, Josef
AU - Auguste, Priscilla
N1 - Funding Information:
Drs. Coresh and Stevens are supported by NIH grants UO1 DK 053869 and UO1 DK 067651 and 1R21DK67651. Ms. Evans is supported through a career development grant by NIDDK. Priscilla Auguste is supported by NIDDK grant 3R01DK076770-01S1. We thank Ms. April Lawner for editorial assistance.
PY - 2008/6
Y1 - 2008/6
N2 - Estimation of glomerular filtration rate (GFR) is central to the diagnosis, evaluation and management of chronic kidney disease (CKD). This review summarizes data on the performance of equations using serum creatinine to estimate GFR, particularly the Modification of Diet in Renal Disease (MDRD) Study equation. The size of studies evaluating GFR estimation equations and their level of sophistication in estimating bias, precision, validity and sensitivity to the source population have improved over the past decade. We update our review from 2006, which included 7 studies with over 500 individuals and 12 studies with 50-499 individuals with measured GFR evaluating the MDRD Study and Cockcroft-Gault equations. More recent studies include an individual level pooling analysis of 5504 participants in 10 studies which showed that creatinine calibration to reference methods improved the performance of the MDRD Study equation but increased bias for the Cockcroft-Gault equation. The MDRD Study equation had a bias of 3.0%, interquartile range of 29.0% and percentage of estimates within 30% of the measured GFR value (P30) of 82% for estimates below 60 mL/(min × 1.73 m2). Above this value, the bias was greater (8.7%) and estimates are less useful since 30% error is a large absolute error in GFR. Results vary across studies but are generally similar with disappointing performance in the high GFR range, which is of particular interest in early diabetic nephropathy. New equations using serum creatinine can reduce the bias present in the high GFR range but are unlikely to dramatically improve precision, suggesting a need for additional markers. Finally, algorithms are needed to tailor clinical practice based on data from GFR estimates and other participant characteristics, including the source population and level of proteinuria.
AB - Estimation of glomerular filtration rate (GFR) is central to the diagnosis, evaluation and management of chronic kidney disease (CKD). This review summarizes data on the performance of equations using serum creatinine to estimate GFR, particularly the Modification of Diet in Renal Disease (MDRD) Study equation. The size of studies evaluating GFR estimation equations and their level of sophistication in estimating bias, precision, validity and sensitivity to the source population have improved over the past decade. We update our review from 2006, which included 7 studies with over 500 individuals and 12 studies with 50-499 individuals with measured GFR evaluating the MDRD Study and Cockcroft-Gault equations. More recent studies include an individual level pooling analysis of 5504 participants in 10 studies which showed that creatinine calibration to reference methods improved the performance of the MDRD Study equation but increased bias for the Cockcroft-Gault equation. The MDRD Study equation had a bias of 3.0%, interquartile range of 29.0% and percentage of estimates within 30% of the measured GFR value (P30) of 82% for estimates below 60 mL/(min × 1.73 m2). Above this value, the bias was greater (8.7%) and estimates are less useful since 30% error is a large absolute error in GFR. Results vary across studies but are generally similar with disappointing performance in the high GFR range, which is of particular interest in early diabetic nephropathy. New equations using serum creatinine can reduce the bias present in the high GFR range but are unlikely to dramatically improve precision, suggesting a need for additional markers. Finally, algorithms are needed to tailor clinical practice based on data from GFR estimates and other participant characteristics, including the source population and level of proteinuria.
KW - Cockcroft-Gault
KW - GFR estimating equations
KW - GFR estimation
KW - Glomerular filtration rate (GFR)
KW - MDRD Study
KW - Serum creatinine
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U2 - 10.1080/00365510802141140
DO - 10.1080/00365510802141140
M3 - Article
C2 - 18569962
AN - SCOPUS:45849088015
SN - 0036-5513
VL - 68
SP - 30
EP - 38
JO - Scandinavian Journal of Clinical and Laboratory Investigation
JF - Scandinavian Journal of Clinical and Laboratory Investigation
IS - SUPPL. 241
ER -