Formula estimation of glomerular filtration rate: have we gone wrong?

Giles, Paul; Fitzmaurice, David

doi:10.1136/bmj.39226.400694.80

Cited by 40 publications

(20 citation statements)

References 14 publications

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“…We extend this opinion to further state that to differentiate stage 1 CKD from stage 2 is unhelpful in clinical daily practice and should be abandoned. This has been also suggested by other authors [25, 27, 28] and is also stated in the Australian guidelines (CARI guidelines) [29]. …”

Section: Other Limitations Of the Mdrd Study Equationmentioning

confidence: 53%

“…However, in other subjects with kidney disease, the accuracy and the precision of the equation are less impressive. Thus, for hospitalized patients, especially those in intensive care and in transplantation, all formula-based estimates of eGFR are prone to substantial error [27, 30, 31]. This is not only because of reduced activity and muscle mass, but also because of day-to-day changes in kidney function.…”

Section: Mdrd Study Equation In Ckd Patients: An Estimate That Is Notmentioning

confidence: 99%

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Formula-Based Estimates of the GFR: Equations Variable and Uncertain

Delanaye

Cohen²

2008

Nephron Clin Pract

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Regarding the prevalence of chronic kidney disease in the population, estimation of glomerular filtration rate is of importance. Creatinine-based formulas are thus useful as the first step of a prevention strategy. Several creatinine-based formulas have been published. Among these, the Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) study equation are the most used by physicians. The latter may be automatically reported by laboratories and has thus great success. However, these formulas have limitations. First, the MDRD formulas are not applicable to all populations, notably the healthy one and the patients with abnormal weight (anorectic or obese). Second, we evoke the limitations in the precision of the formulas linked to analytical aspects. Indeed, these analytical limitations remain significant even if they are improved by creatinine standardization. Lastly, we briefly mention the potential impact of these limitations on the epidemiology and the staging of chronic kidney disease.

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Section: Other Limitations Of the Mdrd Study Equationmentioning

confidence: 53%

Section: Mdrd Study Equation In Ckd Patients: An Estimate That Is Notmentioning

confidence: 99%

Formula-Based Estimates of the GFR: Equations Variable and Uncertain

Delanaye

Cohen²

2008

Nephron Clin Pract

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“…It is mainly helpful for staging disease in patients with stage 3-5 CKD. [23,29] This is the main reason that we used cutoff point of 60 cc/min/1.73 m 2 as the definition of low GFR in our study. It seems that the MDRD formula may be the best formula available for GFR estimating, but it is based on a serum creatinine.…”

Section: Estimating Equations Of Egfrmentioning

confidence: 99%

Screening for Decreased Renal Function in Taxi Drivers in Tehran, Iran

Mahdavi‐Mazdeh

Nazri

Hajghasemi³

et al. 2010

Renal Failure

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Background and objectives. The rapid increase in end stage renal disease (ESRD) prevalence, plus the enormous cost of treatment, necessitates an urgent approach to implement strategies to prevent development and progression of ESRD, especially in the developing world. Screening that leads to early identification and treatment has been recommended, as it may slow or prevent progression to a more expensive and disabling stage of the disease and thus may save lives as well as finite resources. Methods. In 2007, the Healthy City Office of Tehran municipality conducted a large-scale population-based crosssectional survey titled "Kidney Disease Screening of Taxi Drivers in Tehran." Taxi drivers or applicants of purchasing taxi participated in mentioned screening program in the last three months of 2007. Demographic data, blood pressure, and history of hypertension or smoking-and then in specific laboratories creatinine, lipid profile, complete blood count, fasting blood sugar, and urinalysis-have been checked. Results. The survey covered 31,999 people across Tehran (in a population of 12 million) during the study period. The mean and SD of age of participants was 43.77 ± 11.32 (range from18 to 86) years, and 98.4% (31,489) were male. Using the MDRD equation, overall prevalence of eGFR <60 mL/min/1.73 m 2 was 6.5%. However, the prevalence was 6.4% (1982/30949) in males in relation to 13.7% (69/503) in females. Mean and SD of BMI in males and females were 25.90 ± 3.91 and 26.48 ± 4.50 g, respectively. The overall prevalence of proteinuria (≥1+ proteinuria) was 0.6% in males vs. 1.8% in females in normal GFR group. Age, LDL cholesterol, hypertension, blood glucose, and BMI showed to be strong risk factors for low GFR. Education level did not show a significant correlation with low GFR. Discussion and conclusions. The findings of the study insist on the fact that CKD prevalence is significantly higher in old age, females, hypertensives, and uncontrolled diabetic patients. Our ability to decrease the incidence of ESRD is predicated on recognizing those patients with CKD and implementing all preventive strategies.

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“…Reduced and stable eGFR in older people may be much less important than changes in eGFR in the young. 10,20 However, while concerns have also been raised about the validity of eGFR, 21 it is nonetheless currently a better measure than creatinine levels. The latter is an insensitive marker of renal function: up to 50% can be lost before the serum creatinine concentration rises above the normal range, while use of eGFR allows early identification of renal damage, thus affording opportunities for aggressive cardiovascular riskfactor management.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

How ready is general practice to improve quality in chronic kidney disease? A diagnostic analysis

Crinson¹,

Gallagher²,

Thomas³

et al. 2010

Br J Gen Pract

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BackgroundChronic kidney disease (CKD) is associated with increased cardiovascular mortality and morbidity as well as progression to established renal failure. Interventions in primary care, particularly the lowering of blood pressure in individuals with CKD and proteinuria and diabetes, can slow disease progression. This evidence base is codified in national guidance and in a simplified form in pay-forperformance targets. Prior to conducting the QICKD study -a cluster of quality-improvement interventions with reduction of blood pressure as its primary outcome measure -a diagnostic analysis was conducted to assess the relevance of the intended interventions. AimTo understand practitioners' views of CKD and its management. MethodFocus groups were held in five locations across England. Experienced facilitators developed a standardised approach and analysed data using the 'framework' approach.

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Formula estimation of glomerular filtration rate: have we gone wrong?

Abstract: Paul D Giles and David A Fitzmaurice argue that the introduction of estimated glomerular filtration rate to screen for chronic kidney disease in primary care will lead to pressure on specialist services and create patient anxiety without clear proof of benefit

Cited by 40 publications

References 14 publications

Formula-Based Estimates of the GFR: Equations Variable and Uncertain

Formula-Based Estimates of the GFR: Equations Variable and Uncertain

Screening for Decreased Renal Function in Taxi Drivers in Tehran, Iran

How ready is general practice to improve quality in chronic kidney disease? A diagnostic analysis

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