Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation

Vervoort, G.M.M.

doi:10.1093/ndt/17.11.1909

Cited by 206 publications

(175 citation statements)

References 6 publications

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“…The more recent MDRD equation seems more accurate, but it has not been validated in diabetic kidney disease (10). Its superiority over the Cockcroft-Gault formula has been mentioned in some (14), but not all (15,16), recent reports.…”

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confidence: 97%

Estimation of Glomerular Filtration Rate in Diabetic Subjects

Lasseur²,

et al. 2005

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OBJECTIVE -The Cockcroft-Gault formula is recommended for the evaluation of renal function in diabetic patients. The more recent Modification of Diet in Renal Disease (MDRD) study equation seems more accurate, but it has not been validated in diabetic patients. This study compares the two methods.RESEARCH DESIGN AND METHODS -In 160 diabetic patients, we compared the Cockcroft-Gault formula and MDRD equation estimations to glomerular filtration rates (GFRs) measured by an isotopic method ( 51 Cr-EDTA) by correlation studies and a Bland-Altman procedure. Their accuracy for the diagnosis of moderately (GFR Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 ) or severely (GFR Ͻ30 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 ) impaired renal function were compared with receiver operating characteristic (ROC) curves.RESULTS -Both the Cockcroft-Gault formula (r ϭ 0.74; P Ͻ 0.0001) and MDRD equation (r ϭ 0.81; P Ͻ 0.0001) were well correlated with isotopic GFR. The Bland-Altman procedure revealed a bias for the MDRD equation, which was not the case for the Cockcroft-Gault formula. Analysis of ROC curves showed that the MDRD equation had a better maximal accuracy for the diagnosis of moderate (areas under the curve [AUCs] 0.868 for the Cockcroft-Gault formula and 0.927 for the MDRD equation; P ϭ 0.012) and severe renal failure (AUC 0.883 for the CockcroftGault formula and 0.962 for the MDRD equation; P ϭ 0.0001). In the 87 patients with renal insufficiency, the MDRD equation estimation was better correlated with isotopic GFR (Cockcroft-Gault formula r ϭ 0.57; the MDRD equation r ϭ 0.78; P Ͻ 0.01), and it was not biased as evaluated by the Bland-Altman procedure.CONCLUSIONS -Although both equations have imperfections, the MDRD equation is more accurate for the diagnosis and stratification of renal failure in diabetic patients. Diabetes Care 28:838 -843, 2005D iabetic nephropathy affects 25-40% of diabetic patients (1), and diabetes is the leading cause of endstage renal disease (ESRD) in developed countries (2). Mainly because of the high prevalence and increased life expectancy of type 2 diabetic patients (3), the proportion of patients with both diabetes and ESRD is dramatically growing in developed countries (4). Survival rates are low in such patients because of high cardiovascular risk (5), and medical costs are high (6).The evaluation of renal function is therefore of critical importance in diabetic subjects. Glomerular filtration rate (GFR) is the best measure of overall kidney function in health and disease (7). Serum creatinine concentration is widely used as an indirect marker of GFR, but it is influenced by muscle mass and diet (8). GFR can be directly measured by infusion of external substances such as inulin or 51 Cr-EDTA (9), but these methods are expensive and time consuming. The use of prediction equations to estimate GFR from serum creatinine and other variables (age, sex, race, and body size) is therefore recommended by the National Kidney Foundation for the diagnosis and stratification of chronic kidney diseases (10). According to these guideline...

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confidence: 97%

Estimation of Glomerular Filtration Rate in Diabetic Subjects

Lasseur²,

et al. 2005

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“…Validation of the CG and MDRD formulas has been attempted in individuals with known renal disease and normal SCr levels (7), patients with early diabetic nephropathy (8), and individuals without kidney disease (8 -12). However, the different methods used to measure GFR and, more important, the uncertainty about the calibration in SCr measurements limit the interpretation of these results.…”

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confidence: 99%

Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations in the Estimation of GFR in Health and in Chronic Kidney Disease

Poggio

Wang

Greene

et al. 2005

Journal of the American Society of Nephrology

591

395

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The performance of the Modification of Diet in Renal Disease (MDRD) and the Cockcroft-Gault (CG) equations as compared with measured 125 I-iothalamate GFR (iGFR) was analyzed in patients with chronic kidney disease (CKD) and in potential kidney donors. All outpatients (n ‫؍‬ 1285) who underwent an iGFR between 1996 and 2003 were considered for analysis. Of these, 828 patients had CKD and 457 were potential kidney donors. Special emphasis was put on the calibration of the serum creatinine measurements. In CKD patients with GFR <60 ml/min per 1.73 m 2 , the MDRD equation performed better than the CG formula with respect to bias (؊0.5 versus 3.5 ml/min per 1.73 m 2 , respectively) and accuracy within 30% (71 versus 60%, respectively) and 50% (89 versus 77%, respectively). Similar results are reported for 249 CKD patients with diabetes. In the kidney donor group, the MDRD equation significantly underestimated the measured GFR when compared with the CG formula, with a bias of ؊9.0 versus 1.9 ml/min per 1.73 m 2 , respectively (P < 0.01), and both the MDRD and CG equations overestimated the strength of the association of GFR with measured serum creatinine. The present data add further validation of the MDRD equation in outpatients with moderate to advanced kidney disease as well as in those with diabetic nephropathy but suggest that its use is problematic in healthy individuals. This study also emphasizes the complexity of laboratory calibration of serum creatinine measurements, a determining factor when estimating GFR in both healthy individuals and CKD patients with preserved GFR.

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Section: Discussionmentioning

confidence: 89%

“…However, we do not believe this to be a serious limitation of our study as tubular secretion of creatinine is mainly an important contributor to urinary creatinine in subjects with GFR below 25 ml/min per 1.73 m 2 of BSA [17,23] and our subjects had normal or mildly decreased renal function. Furthermore, it has been demonstrated that creatinine clearance is adequate for measuring the GFR when compared to inulin clearance in subjects with normal GFR with or without type 1 diabetes [17]. In Japanese subjects, creatinine clearance is an accepted approach for measuring GFR as it has been demonstrated not only to have an excellent correlation with plasma clearance methods like In-111 DTPA but also to be as accurate as gamma camera methods like Tc-99m DTPA scintigraphy in estimating renal function [24].…”

Section: Discussionmentioning

confidence: 89%

“…In addition, the utility of the MDRD equation in individuals with normal renal function, diabetic nephropathy or who may vary in glucose tolerance status is still controversial [12,17,18]. Therefore, we compared the estimates derived using the Cockcroft-Gault and the MDRD equations to creatinine clearance measured from a 24-hour urinary collection in a cohort of Japanese Americans who had normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

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Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft–Gault equation in screening for impaired kidney function in Japanese Americans

Gerchman

Tong

Utzschneider

et al. 2007

Diabetes Research and Clinical Practice

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The Cockcroft-Gault and the Modification of Diet in Renal Disease (MDRD) Study equations have not been validated in Asian Americans with varying degrees of glucose tolerance. We compared both equations to 24 hour urinary creatinine clearance, the latter as a standard measurement of glomerular filtration rate (GFR), in 398 Japanese Americans (62.1±5.8y, mean±SD) who had normal glucose tolerance (n=138), impaired glucose tolerance (n=136) and diabetes (n=124). Although both the Cockcroft-Gault (r=0.65, P<0.001) and the MDRD (r=0.74, P<0.001) equations correlated well with creatinine clearance, the latter was significantly superior (P=0.013 between r values). ROC curve analysis showed that the area under the curve (AUC) for the MDRD equation was significantly greater than for the Cockcroft-Gault equation (AUC 0.86 vs. 0.80, P=0.015) in classifying subjects as having mildly reduced GFR (<90 ml/min per 1.73 m 2 ). However, both equations overestimated the number of individuals with decreased GFR. We conclude therefore that while the MDRD equation more accurately identifies Asians who are in the early stages of kidney disease, as for other groups, a correction term appears necessary in order to reduce the number of Asian subjects being falsely diagnosed with CKD.

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Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation

Abstract: In subjects with a normal or increased GFR, the new MDRD-prediction equation of GFR is less accurate than creatinine clearance or the Cockcroft-Gault formula, and offers no advantage.

Cited by 206 publications

References 6 publications

Estimation of Glomerular Filtration Rate in Diabetic Subjects

Estimation of Glomerular Filtration Rate in Diabetic Subjects

Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations in the Estimation of GFR in Health and in Chronic Kidney Disease

Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft–Gault equation in screening for impaired kidney function in Japanese Americans

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