Assessing Renal Function Using Cockcroft-Gault and Modification of Diet in Renal Disease Equations in Healthy South Indian Males – A pilot study

Shastry, Rajeshwari; Adhikari, Prabha; Ullal, Sonali; Shenoy, Ashok K

doi:10.3126/ajms.v2i3.5337

Cited by 2 publications

(4 citation statements)

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“…There has been conflicting data in previous studies with respect to this association. A recent study done on 491 subjects from South India [12] had shown the same trend as that of us. It had also been described in other studies that higher BMI was consistently associated with lower MDRD [29] and CKD-EPI [30], while a few others had depicted a non-linear relationship between eGFR decline per year and BMI [31], [32].…”

Section: Discussionsupporting

confidence: 83%

“…This can be due to different body physique of South Asian population. Similar findings of having an eGFR <90ml/min per 1.73 m 2 by CG and MDRD formula in more than 50% of the study subjects were found in two Indian studies [12], [19].…”

Section: Discussionsupporting

confidence: 83%

“…Validation studies have also been performed on these equations mostly in western parts of the world [3], [7]- [11]. In South Asia that makes around 23.5% of the whole world population according to latest World Bank data available online, a few studies [12]- [15] had compared Cockroft-Gault and MDRD equations but CKD-EPI equation that is relatively newer has never been validated or compared with other equations in this region.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Glomerular Filtration Rate Estimated by Three Methods in a Pakistani Community Cohort

2021

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Background: Estimated glomerular filtration rate (eGFR) has always been considered a better and more accurate method to assess kidney function as compared to serum creatinine. Various equations such as the Cockroft-Gault equation corrected for surface area (CG-CRTD), the four-variable Modification of Diet in Renal Disease equation (MDRD) and 2009 Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) have been derived to estimate GFR. In the South Asian region, the CKD-EPI equation has not been validated or compared with other equations. This study compares eGFR in a Pakistani community cohort calculated by all three equations. Results: Serum creatinine was measured using Kinetic Colorimetric Assay in alkaline medium for 461 individuals age 15 and above. Less than half of the participants (47% by CG-CRTD, 40% by MDRD, 52% by CKD-EPI) had eGFR ³90 ml/min per 1.73 m2 and for participants with eGFR ³120 ml/min per 1.73 m2 , the percentages were even lower (15%, 12%, and 22% respectively). All the equations were linearly associated with each other, but the error estimation depicted that majority of the individual differences were ≥5 and ≤-5, and very few were within ±1 indicating less degree of agreement between the formulas. Age was significantly but negatively correlated with all the three formulas in their classification of patients as per eGFR Conclusion: Our study found that the values of estimated GFR are on lower side for Pakistanis as compared to the western population. The equations available for estimation of GFR even though associated linearly with each other have significant individual differences. Thirdly, using eGFR to classify CKD should have a better consideration of physiological age-related decline in GFR. All of these findings necessitate having an adequately funded randomized study measuring true GFR of this population and at the same time validating eGFR equations to find the normal GFR ranges of South Asians.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Comparison of Glomerular Filtration Rate Estimated by Three Methods in a Pakistani Community Cohort

2021

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“…These studies have variable outcomes 4,5 . However, not many studies have validated the use of these equations in the Indian population.…”

Section: Introductionmentioning

confidence: 99%

Improvement in estimates of GFR by using fat-free mass as compared to body weight in Indians: pilot study

Kulkarni,

Yajnik,

Sampathkumar

et al. 2023

Preprint

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Background: Estimated glomerular filtration rate (eGFR) may be calculated by different equations with variable accuracy. The accuracy of creatinine-based eGFR equations may vary across ethnic groups. These are also influenced by differences in body composition. Many populations have higher adiposity for a given body mass index, this disparity is very striking in Indians and has led to the description of a thin-fat Indian. We undertook a pilot study to compare eGFR estimated from clinical equations using fat-free mass instead of total body weight, in healthy Indians. Methods and results: We studied 26 healthy Indian volunteers (11 men, 15 women), aged 49 (34,55) years [Median (Min, Max)]. We recorded vitals, anthropometric and biochemical measurements. eGFR values were estimated by Cockcroft-Gault (CG-BSA), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae. eGFR values based on the CG-BSA equation were re-calculated after replacing the coefficient of total body weight with fat-free mass and muscle mass (obtained by BIA) and lean mass (obtained by DEXA scan). We used Tc 99m DTPA renogram for GFR measurement as the gold standard. Median eGFR using conventional formulae overestimated the GFR when compared to mGFR (81 ml/min/1.73m2); CG-BSA equation (99 mL/min/1.73 m2); EPI-CKD equation (97 mL/min/1.73 m2 ) and MDRD equation (89 mL/min/1.73 m2). Of the CG-BSA formulae, eGFR using total Body weight is the farthest from gold standard. And estimated GFR using fat free mass had closest median (67 mL/min/1.73 m2) to the gold standard (79 mL/min/1.73 m2 ) Bland-Altman analysis showed the Mean difference of Fat free mass-based CG-BSA formula from the gold standard was the lowest of all four CG formulae (-12.009, CI -19.266 to -4.752); showing that it had the best agreement with the gold standard of the four CG-BSA formulae. Also, it showed that the mean difference of MDRD formula from gold standard is the lowest (9.191, CI 1.008 to 17.375) followed by Cockcroft Gault formula using Fat Free mass (-12.009, CI -19.266 to -4.752). Mean difference of EPI formula (15.151, CI 8.182 to 22.120) and Cockcroft Gault formula using Muscle mass (-15.809, CI -22.756 to -8.861) follow, with very similar Limits of Agreement (LOA). Conclusion: This pilot study showed that existing conventional eGFR equations CG-BSA, MDRD, and CKD- EPI overestimate eGFR in healthy Indian subjects. The conventional CG-BSA had the least agreement with measured GFR by the gold standard. However, the replacement of coefficient of total body weight by FFM, MM and LM in the CG-BSA formula improved the estimates of eGFR in healthy Indian volunteers.

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Assessing Renal Function Using Cockcroft-Gault and Modification of Diet in Renal Disease Equations in Healthy South Indian Males – A pilot study

Cited by 2 publications

References 19 publications

Comparison of Glomerular Filtration Rate Estimated by Three Methods in a Pakistani Community Cohort

Comparison of Glomerular Filtration Rate Estimated by Three Methods in a Pakistani Community Cohort

Improvement in estimates of GFR by using fat-free mass as compared to body weight in Indians: pilot study

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