New results from the Modification of Diet in Renal Disease study: the importance of clinical outcomes in test strategies for early chronic kidney disease

Abstract

A formula derived from the Modification of Diet in Renal Disease (MDRD) study in chronic renal disease is widely used to estimate glomerular filtration rate (GFR). Recently a ten-year follow-up of MDRD participants evaluated four tests of kidney function measured at baseline as predictors of important long-term clinical outcomes. Surprisingly, neither formula-estimated GFR nor reference method GFR showed a clear advantage over simple creatinine measurement whereas another test, cystatin C, looked more promising. This raises important points of principle in terms of how the usefulness of test strategies should be assessed. Data on clinical outcomes are an essential ingredient in this process.

The value of a formula including haematocrit, blood urea and gender (HUGE) as a screening test for chronic renal insufficiency

“…However, the use of eGFR to test patients without previously recognized CKD is not only controversial, but maybe ill-advised (13).…”

The Global Burden of Chronic Kidney Disease: How Valid Are the Estimates?

“…For example, recent studies have suggested that the MDRD calculated eGFR was no better than serum creatinine concentration alone in ‘diagnosing’ CKD, using the current KDOQI criteria [25, 26]. The necessity for repeated measurement to confirm the ‘chronicity’ of the decline in eGFR or the persistence of the manifestations of kidney damage imposes a severe limitation upon cross-sectional epidemiological studies.…”

Routine reporting of estimated glomerular filtration rate: not ready for prime time

“…1,6 Knowledge of eGFR could also aid the selection of safe and effective dosing regimens for potentially toxic drugs that are eliminated largely by glomerular filtration, although the superiority of the MDRD-estimated eGFR over other estimates for this purpose is not well established. 7 Undoubtedly, the concept of eGFR has raised the profile of CKD in the community at large.…”