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, Emilio D.; Wang, Xuelei; Greene, Tom; Lente, F Van; Hall, Phillip M.

doi:10.1681/asn.2004060447

Cited by 591 publications

(460 citation statements)

References 18 publications

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“…Current evidence demonstrated that revised 4 variable MDRD study equation is superior over CG equation [16]; as CG equation having several practical limitations [5]. While, extensive evaluation of the MDRD Study equation showed good performance in populations with lower levels of GFR but variable performance in those with higher levels [17]. Variability among clinical laboratories in calibration of Scr assays [18] introduces error in GFR estimates, especially at high levels of GFR [19].…”

Section: Discussionmentioning

confidence: 99%

Underestimation of Impaired Kidney Function with Serum Creatinine

2010

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Serum creatinine (SCr) levels are frequently used as a screening test to assess impaired renal function; however, patients can have significantly decreased glomerular filtration rate (GFR) with normal SCr values and making the recognition of kidney dysfunction more difficult. Hence, this study was designed to determine the extent of misclassification of the patients who have significantly reduced GFR as calculated by reexpressed four variable modification of diet in renal disease (MDRD) equation but, normal range of SCr. The study included 1040 in and out patients referred by physicians for serum creatinine measurement. When an exclusion criterion was applied 928 patients were qualified for the study. SCr was measured in 928 patients by a Roche kinetic compensated Jaffe's assay. GFR was calculated using reexpressed four variable MDRD study equation. Of the 928 patients 270 (29.1%) had renal dysfunction on the basis of eGFR (\60 ml/min/1.73 m 2 ). However, with SCr only 162 (17.5%) patients had abnormal renal function ([1.5 mg/dl) and SCr values misrepresented (108) 11.6% patients with impaired kidney function. In addition, more females, about 15% were failed to detect by SCr method in contrast to males of 9%. This study documented that, a large proportion of patients with impaired renal function are not diagnosed if clinicians rely solely on normal SCr as evidence of normal renal function. Inclusion of eGFR calculated by re-expressed 4 variable MDRD equation may facilitates the early identification and intervention of patients with renal impairment.

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Section: Discussionmentioning

confidence: 99%

Underestimation of Impaired Kidney Function with Serum Creatinine

2010

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“…As an example, the original and IDMS-traceable MDRD formula (serum creatinine in lmol/L) are presented below: (27). After the original MDRD validation study (28), which included only 6% diabetic patients, additional validation studies were performed in diabetic patients (29).…”

Section: Mdrd Equationmentioning

confidence: 99%

“…The MDRD equation was validated in patients with renal disease and appears not to be reliable as an estimate of GFR at values above 60 mL/min/1.73 m 2 (29), although this would not compromise its use in identifying patients at risk for NSF. However, in patients with GFR at the lowest range, the MDRD equation may overestimate ''true'' GFR.…”

Section: Mdrd Equationmentioning

confidence: 99%

Estimation of renal function in patients with chronic kidney disease

Kooman

2009

Magnetic Resonance Imaging

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The risk of nephrogenic systemic fibrosis after gadolinium exposure is inversely related to renal function. Various methods are available to assess the glomerular filtration rate (GFR). Prediction formulas based on serum creatinine, such as the abbreviated Modification of Diet in Renal Disease (MDRD) formula, are most commonly used and appear acceptable for clinical purposes in the majority of patients with chronic renal failure. However, especially in patients at the extremes of body composition, the results from creatinine‐based equations should be interpreted with caution. In those patients, additional methods, such as timed urine collections, predictions based on cystatin, single‐shot radiotracer methods, or, optimally, inulin clearance could be considered. In this review, the strengths and limitations of different methods to assess GFR are discussed. Apart from inulin clearance, no method can be considered the gold standard in the assessment of GFR. In cases of doubt, the decision to use gadolinium‐enhanced magnetic resonance imaging should always be based on clinical risk–benefit judgment. J. Magn. Reson. Imaging 2009;30:1341–1346. © 2009 Wiley‐Liss, Inc.

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“…However, to make it applicable to different racial/ethnic groups, it was modified by the insertion of a correction factor. Compared to the direct estimation of GFR, the MDRD equation was better than the Cockcroft-Gault equation at predicting GFR in subjects with CKD and renal failure with or without diabetes [10][11][12]. The National Kidney Foundation recommends a simplified and thus abbreviated form of this equation for estimating GFR [6].…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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

Cited by 591 publications

References 18 publications

Underestimation of Impaired Kidney Function with Serum Creatinine

Underestimation of Impaired Kidney Function with Serum Creatinine

Estimation of renal function in patients with 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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