Cockcroft-Gault formula is biased by body weight in diabetic patients with renal impairment

Rigalleau, Vincent; Lasseur, Catherine; Perlemoine, Caroline; Barthe, Nicole; Raffaitin, C.; Chauveau, Philippe; Combe, Christian; Gin, H.

doi:10.1016/j.metabol.2005.07.014

Cited by 71 publications

(49 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most studies showed a larger bias in stage 2 than in stage 3 CKD for Cockcroft-Gault or MDRD (6,7,19,20), which is in contrast to our findings. The relatively small number of patients in the subgroups in our study as well as in some of the aforementioned studies (7,19) could be an explanation for this difference; however, studying the accuracies over the subgroups, all formulas showed a pattern in which the accuracies became smaller per GFR subgroup, which is in line with others (6,20). Furthermore, the regression analysis that was based on the absolute bias per patient did show a linear relation between the GFR and the absolute bias.…”

Section: Discussioncontrasting

confidence: 99%

Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

Michels

Grootendorst

Verduijn

et al. 2010

Clinical Journal of the American Society of Nephrology

504

384

View full text Add to dashboard Cite

Background and objectives: We compared the estimations of Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to a gold standard GFR measurement using 125 I-iothalamate, within strata of GFR, gender, age, body weight, and body mass index (BMI).Design, setting, participants, & measurements: For people who previously underwent a GFR measurement, bias, precision, and accuracies between measured and estimated kidney functions were calculated within strata of the variables. The relation between the absolute bias and the variables was tested with linear regression analysis.Results: Overall (n ‫؍‬ 271, 44% male, mean measured GFR 72.6 ml/min per 1.73 m 2 [SD 30.4 ml/min per 1.73 m 2 ]), mean bias was smallest for MDRD (P < 0.01). CKD-EPI had highest accuracy (P < 0.01 compared with Cockcroft-Gault), which did not differ from MDRD (P ‫؍‬ 0.14). The absolute bias of all formulas was related to age. For MDRD and CKD-EPI, absolute bias was also related to the GFR; for Cockcroft-Gault, it was related to body weight and BMI as well. In all extreme subgroups, MDRD and CKD-EPI provided highest accuracies.Conclusions: The absolute bias of all formulas is influenced by age; CKD-EPI and MDRD are also influenced by GFR. Cockcroft-Gault is additionally influenced by body weight and BMI. In general, CKD-EPI gives the best estimation of GFR, although its accuracy is close to that of the MDRD.

show abstract

Section: Discussioncontrasting

confidence: 99%

Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

Michels

Grootendorst

Verduijn

et al. 2010

Clinical Journal of the American Society of Nephrology

504

384

View full text Add to dashboard Cite

show abstract

“…Consistent with previous studies (12,13), bias of the Cockcroft-Gault formula was most pronounced in lean subjects, diminishing with increasing body weight. Conversely, bias of the MDRD equation increased with increasing body weight.…”

Section: Body Weight Influence On Gfr Estimatorssupporting

confidence: 91%

“…In obese patients with established kidney disease, the CockcroftGault equation overestimates GFR while underestimating GFR in lean subjects; performance of the MDRD equation in such patients was consistent regardless of weight (12).…”

Section: Body Weight Influence On Gfr Estimatorsmentioning

confidence: 82%

Influence of Body Weight on the Performance of Glomerular Filtration Rate Estimators in Subjects With Type 2 Diabetes

et al. 2008

View full text Add to dashboard Cite

“…In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6). The MDRD equation is superior to the Cockcroft and Gault equation: it is more accurate (7,8), more robust when glucose control is poor (9), and not biased by body weight (10), which is of considerable importance because of the frequent association of type 2 diabetes, and CKD (11), with obesity. Most of the recent reports on CKD in diabetic patients rely on MDRD e-GFR (12)(13)(14)(15)(16).…”

mentioning

confidence: 99%

Normoalbuminuric Renal-Insufficient Diabetic Patients

et al. 2007

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations (albumin excretion rate Ͼ30 mg/24 h or estimated glomerular filtration rate [GFR] Ͻ60 ml/min per 1.73 m 2 ) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?RESEARCH DESIGN AND METHODS -A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) Ͻ60 ml/min per 1.73 m 2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 Ϯ 11 months.RESULTS -The mean MDRD e-GFR (41.3 Ϯ 13.1 ml/min per 1.73 m 2 ) did not significantly differ from the i-GFR (45.6 Ϯ 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 Ϯ 27 vs. 160 Ϯ 71 mol/l, P Ͻ 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic retinopathy, and their HDL cholesterol and hemoglobin were higher (P Ͻ 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric: 10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P Ͻ 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the AER increased in the microalbuminuric patients (P Ͻ 0.05), and the sCr increased in the macroalbuminuric patients (P Ͻ 0.01).CONCLUSIONS -Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR below 60 ml/min per 1.73 m 2 do really have a GFR below 60 ml/min per 1.73 m 2 . However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or death is lower. Diabetes Care 30:2034-2039, 2007T wenty-five to forty percent of patients with diabetes have kidney damage (1), and diabetes is the first cause of end-stage renal disease in most countries (2). The early detection of chronic kidney disease (CKD) in diabetic patients is therefore of critical importance. The conventional approach for screening is the determination of the albumin excretion rate (AER). However, a substantial proportion of normoalbuminuric diabetic patients may present with a reduced glomerular filtration rate (GFR): their rates have been reported to be ϳ20% based on GFR Ͻ60 ml/min per 1.73 m 2 in type 2 diabetes (3) and in type 1 diabetes based on GFR Ͻ90 ml/min per 1.73 m 2 with more advanced glomerular lesions (4). In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6...

show abstract

Cockcroft-Gault formula is biased by body weight in diabetic patients with renal impairment

Cited by 71 publications

References 22 publications

Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

Influence of Body Weight on the Performance of Glomerular Filtration Rate Estimators in Subjects With Type 2 Diabetes

Normoalbuminuric Renal-Insufficient Diabetic Patients

Contact Info

Product

Resources

About