Performance of Cockcroft-Gault, MDRD, and CKD-EPI in estimating prevalence of renal function and predicting survival in the oldest old

Abstract

BackgroundThe question for prevalence estimation and validation of the various eGFRs in old age is still under debate. To assess renal function with increasing age, we estimated mean eGFR, in subjects aged 20–85 years. Furthermore, we assessed prevalence of eGFR in a population-based sample of 85 year olds and investigated the performance of these eGFRs in predicting mortality in the oldest old.MethodsRenal function with increasing age was assessed in subjects aged 20–85 years from the Bronovo Study Cohort. We estimated prevalences of eGFRs and mortality risks in a population-based study of persons aged 85 years and older, the Leiden 85-plus Study. The GFRs were estimated by three different formulas.ResultsAfter the age of 70 years, the C-G tended to give relatively lower eGFRs. An eGFR < 60 was found in 90% of the subjects aged 85 years as calculated by C-G, in 55% of the subjects using MDRD and in 68% of the 85 year old subjects as calculated by CKD-EPI. When renal function was <30 ml/min/1.73 m2, an increased mortality risk was observed by C-G (HR 1.9 (95% CI 1.1-3.3)), by MDRD (HR 3.5 (95% CI 1.8-6.7)), whereas by CKD-EPI significance was not reached (HR 2.4 (95% CI 0.9-6.4)).ConclusionsOur study demonstrates that in subjects above age 70, C-G gives lower estimates of renal function when compared to MDRD and CKD-EPI. Furthermore, prevalence of renal dysfunction (CKD stage 1–3) at age 85 years was highest for C-G (90%), lowest for MDRD (55%), and 68% for CKD-EPI. Moreover, we found that in subjects aged 85 years MDRD predicted mortality best.

The Potential Effect of Using the Cockcroft-Gault Method on Tenofovir-Associated Renal Impairment Reports and on Clinical Decisions Regarding Tenofovir Use in Individual Patients: Implications for the Future

“…The C-G method was associated with lower eGFR computations. The authors also found that the CKD-EPI eGFR closely approximated the gold-standard [15,16]. In their study, Matsushita et al found that CKD-EPI, which out-performs MDRD, led to the reclassification of many patients from lower to higher renal function categories [17].…”

Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥75 years after radical cystectomy for treatment of bladder cancer

“…Although the CG formula is widely used, it is not well validated for elderly patients. It is reported that this formula tends to give relatively lower eGFRs for patients older than 70 years [19]. Median (range) eGFR for the younger and older patients was 60.9 (12.5-120.5) and 44.1 (14.8-85.2) ml/min/1.73 m 2 , respectively.…”

Disparities in the Estimation of Glomerular Filtration Rate According to Cockcroft‐Gault, Modification of Diet in Renal Disease‐4, and Chronic Kidney Disease Epidemiology Collaboration Equations and Relation With Outcomes in Patients With Acute Coronary Syndrome

“…However, Carter et al showed scarce differences between the CKD‐EPI and MDRD equations, and among the elderly patients, CKD‐EPI equation increased CKD prevalence . Another study focusing on the effect of age, the Cockcroft‐Gault equation, estimated lower eGFRs, and Cockcroft‐Gault and MDRD equations predicted mortality, but not CKD‐EPI …”