Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft–Gault equation in screening for impaired kidney function in Japanese Americans

Abstract

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.

Predialysis Health, Dialysis Timing, and Outcomes among Older United States Adults

“…[39][40][41] Also, creatinine-based measures of eGFR may misclassify patients with poor nutritional status and/or sarcopenia, 11,42 which is often seen among older dialysis patients. 43 Furthermore, creatinine-based measures of eGFR have not been well studied among Asian Americans, 44,45 which could have influenced our results. In an attempt to account for these limitations, we carefully matched patients on numerous predialysis factors, markers of nutritional status, and comorbidities.…”

Comparison of prediction equations to estimate glomerular filtration rate in Chinese patients with chronic kidney disease

“…The precision was measured as the width between the 95% limits of agreement. A prior acceptable tolerance for the difference between eGFR and sGFR was defined as twice the limit for CKD stages, which is 60 mL/min/1.73 m 2 7 . The difference between eGFR and sGFR was regressed against the average of eGFR and sGFR 20 .…”

“…For example, when MDRD equations were applied to black individuals or Japanese Americans, a coefficient should be used. [5][6][7] The possible mechanism of this racial difference, whether the relative performance of the estimated GFR (eGFR) estimates truly a function of ethnicity or is related only to factors, such as lean body mass and meat intake, remains to be determined. Disagreement remains concerning whether these equations are generalisable to Chinese patients.…”

The relationship between three eGFR formulas and hospitalization for heart failure in 54 486 individuals with type 2 diabetes

“…The MDRD equation for eGFR is widely used today because it is easy to use in laboratory settings, because, unlike Cockcroft–Gault, weight measurements are not required. Earlier studies comparing eGFR with more accurate methods have supported the use of MDRD over Cockcroft–Gault .…”

“…In another study that did not specifically evaluate patients with diabetes, comparable risk increases were seen by Manjunath et al [27] for de novo atherosclerotic CVD, with a 2.5-fold increase in risk between patients with eGFR 30-59 mL/min/ 1.73 m 2 (MDRD) and >90 mL/min/1.73 m 2 . The MDRD equation for eGFR is widely used today [28] because it is easy to use in laboratory settings, because, unlike Cockcroft-Gault, weight measurements are not required. Earlier studies comparing eGFR with more accurate methods have supported the use of MDRD over Cockcroft-Gault [29,30].…”