Applicability of estimated glomerular filtration rate in stratifying chronic kidney disease

Abstract

eGFR is inversely associated with increasing age and female gender. MDRD derived eGFR fails to completely compensate for age and gender variations and thus different action limits may be required. Small but significant numbers of patients progressed to stages 4 and 5 CKD. Additional clarity in describing "progressive fall in eGFR" in the guidelines would improve identification of the population most at risk.

Is estimated glomerular filtration rate suitable for stratification of chronic kidney disease?

“…The median and 95 % confidence intervals of e-GFR in each decade of age are given in Table I. The e-GFR values observed in our study population were globally higher than those reported by Khatami et al [1], and significant differences between genders could be observed in all the decades of age. A strong inverse association was found by univariate regression analysis between age and e-GFR in both genders (men: r520.206; pv0.001; women: r520.551; pv0.001), with a mean decrease in e-GFR for each decade increase in age of 5.7 % in women and 6.1 % in men, respectively.…”

“…Finally, the Kruskal-Wallis test showed a significant difference between decade age and e-GFR for both genders (pv0.001). Overall, the results of our investigation show that e-GFR, as estimated using the MDRD formula, might fail to compensate for age and gender variations, confirming that additional actions might be undertaken to improve its applicability and clinical usefulness [1,2,4]. …”

“…We have read with interest the article by Khatami et al on the applicability of estimated glomerular filtration rate (e-GFR) in stratifying chronic kidney disease (CKD) [1]. It was concluded that the e-GFR is inversely associated with increasing age and female gender, emphasizing that the Modification of Diet in Renal Disease (MDRD) equation might fail to compensate completely for age and gender variations, thus requiring implementation of different action limits.…”

Does stage-3 chronic kidney disease matter?: A systematic literature review

“…Imai et al 42 graphically presented the annual rate of eGFR decline stratified by different age groups (40- Eriksen and Ingebretsen's study, 32 which included only patients with stage-3 CKD, reported that only 6% had a mean eGFR decline greater than 5 mL/min/1.73 m 2 and 27% experienced no decline in function. Khatami et al 38 followed people with eGFR <60 mL/min for 4 years and reported that approximately 4% progressed to stage-4 or stage-5 CKD, 20% regressed to stage-2 CKD and 76% were stable. Orlando et al 40 reported that only 17% of those patients at stage 3 progressed to the next stage during at least 5 years follow-up.…”

“…12 From three studies, it was possible to estimate the proportion of people who did not demonstrate evidence of progressive renalfunction decline: Eriksen and Ingebretsen 32 reported that 27% showed no fall in eGFR during up to 10 years' follow-up; two further studies reported that ≥80% did not show any worsening of CKD stage after up to 5 years' follow-up. 38,40 In practice, Systematic Reviews therefore, the number of patients with stage-3 CKD progressing to ESRD is likely to be low. Looking for other indicators of underlying pathology and markers of kidney damage will be important in helping to identify which patients are at risk of a progressive course.…”