The Mayo Clinic quadratic equation improves the prediction of glomerular filtration rate in diabetic subjects

Rigalleau, Vincent; Lasseur, Catherine; Raffaitin, C.; Perlemoine, Caroline; Barthe, Nicole; Chauveau, Philippe; Combe, Christian; Gin, H.

doi:10.1093/ndt/gfl649

Cited by 52 publications

(31 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PubMed research (last accessed July 2010) recovered only 12 studies with mGFRs Ͼ100 reporting this performance of the CG and MDRD formulas, and their results are presented in Table 2 (6,44,72,90,92,95,99,(103)(104)(105)(106)(107). Comparing CG versus MDRD formula in studies with data for both formulas (6431 subjects) showed similar overall proper classification of the subjects, 64% versus 63%, range 55% to 72% versus 53% to 71%, respectively (6,72,92,95,99,(103)(104)(105)(106)(107). The best performance of CG and MDRD equations was in mGFR group 30 to 59 ml/min per 1.73 m 2 , whereas the worst one was in mGFR groups Ͻ15 and Ͼ90 ml/min per 1.73 m 2 , respectively.…”

Section: Effect Of Egfr On K/doqi-ckd Diagnosing and Stagingmentioning

confidence: 99%

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Botev

Mallié²,

Wetzels³

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryThe GFR has a paramount diagnostic and staging role in the Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease (K/DOQI-CKD). The most widely used serum creatininebased formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). Recently, a new Chronic Kidney Disease Epidemiology Collaboration equation has been developed. Review of the literature revealed that CG and MDRD formulas correctly assigned overall only 64% and 62%, respectively, of the subjects to their actual K/DOQI-CKD classification's GFR groups as determined by measured GFR (mGFR). This suggests that approximately 10 million (38%) subjects may have been misclassified on the basis of estimated CKD prevalence of 26.3 million adults in the United States. The purpose of this review is to help the clinician understand the limitations of using eGFR in daily practice. We also elaborate upon issues such as the differences among markers of mGFR, the validity of adjusting GFR for body surface area in certain populations, the limited data on boundaries for normal mGFR according to age, gender, and race, the need for calibration of a wide spectrum of serum creatinine measurements, the lack of actual eGFR value above 60 ml/min per 1.73 m 2 and reference for normal mGFR in the clinical laboratories' reports, and the performance evaluation of the eGFR formulas. Several pitfalls have to be overcome before we can reliably determine health and disease in daily nephrology practice to preserve the first rule of practicing medicine: primum non nocere.Clin J Am Soc Nephrol 6: 937-950, 2011.

show abstract

Section: Effect Of Egfr On K/doqi-ckd Diagnosing and Stagingmentioning

confidence: 99%

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Botev

Mallié²,

Wetzels³

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…16,39 The MCQ eGFR equation appears to be superior to the MDRD and Cockcroft-Gault formulas in patients without CKD, 16 and studies have shown that the MCQ eGFR does not underestimate normal glomerular filtration rate. 16,39 Additionally, the MDRD eGFR has been shown to be suboptimal as a renal risk predictor in patients with cardiovascular disease. 40 Other limitations include a study population composed of patients cared for by a single tertiary referral practice, lack of systematic evaluation of right ventricular systolic function by echocardiography, and the choice of arbitrary SCr cut points to define normal and abnormal SCr groups.…”

Section: Study Limitationsmentioning

confidence: 99%

Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension

et al. 2008

View full text Add to dashboard Cite

Background-Renal dysfunction predicts mortality in patients with cardiovascular disease. How renal dysfunction relates to hemodynamics and mortality in pulmonary arterial hypertension (PAH) remains unclear. Methods and Results-We performed a cohort study of 500 patients with World Health Organization group I PAH from 1982 to 2006 with data on demographics, comorbidities, medications, functional class, laboratory tests, exercise testing results, and hemodynamics. Serum creatinine (SCr) was determined on entry into the study (initial PAH clinic visit). Vital status was determined from hospital records and the Social Security Death Index. We used a Cox proportional hazards analysis to determine whether SCr was an independent predictor of mortality. Mean age on entry into the study was 48Ϯ14 years, and 79% of subjects were female. Mean SCr was 1.05Ϯ0.35 mg/dL. Elevated SCr was associated with higher right atrial pressure and lower cardiac index. During a median follow-up of 3.5 years, 279 deaths (55.8% of the cohort) occurred. Compared with patients with SCr Ͻ1.0 mg/dL, those with SCr 1.0 to 1.4 mg/dL and SCr Ͼ1.4 mg/dL had an increased hazard ratio of death (unadjusted hazard ratio 1.65, 95% confidence interval 1.26 to 2.17, PϽ0.0001 for SCr 1.0 to 1.4 mg/dL; unadjusted hazard ratio 2.54, 95% confidence interval 1.73 to 3.71, PϽ0.0001 for SCr Ͼ1.4 mg/dL). On multivariable analysis, we found a significant interaction between SCr and right atrial pressures (interaction PϽ0.0001); increased SCr best predicted death in patients with right atrial pressure Ͻ10 mm Hg. Conclusions-Renal dysfunction is associated with a worse hemodynamic profile and is an independent predictor of mortality in PAH. Measurement of SCr is practical and offers a simple way to noninvasively predict outcome.

show abstract

“…Most of these patients, therefore, really had a GFR Ͻ60 ml/min per 1.73 m 2 , which would have been missed for 71% of them if their renal function had been assessed solely by a serum creatinine level Ͼ120 mol/l. Despite its underestimation of GFR, mainly for GFR Ͼ60 ml/min per 1.73 m 2 (18,23), and the increase in the number of detected CKD (12,24), the use of the MDRD equation as recommended by the American Diabetes Association is of interest, especially when AER is normal.…”

Section: Outcomementioning

confidence: 99%

“…Most of the recent reports on CKD in diabetic patients rely on MDRD e-GFR (12)(13)(14)(15)(16). This equation may however not be ideal for screening CKD, as it is known to underestimate normal and high GFR (17,18): some of the MDRD-based CKD diagnosis may stem from this underestimation (19), particularly in normoalbuminuric patients. Furthermore, the progressive nature of normoalbuminuric CKD has been argued from studies based on measured GFR, reported by one group (3,20), and its association with complications relies on reports in Asian diabetic subjects, who are known to have a high incidence of CKD (14).…”

mentioning

confidence: 99%

Normoalbuminuric Renal-Insufficient Diabetic Patients

et al. 2007

View full text Add to dashboard Cite

OBJECTIVE -About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations (albumin excretion rate Ͼ30 mg/24 h or estimated glomerular filtration rate [GFR] Ͻ60 ml/min per 1.73 m 2 ) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?RESEARCH DESIGN AND METHODS -A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) Ͻ60 ml/min per 1.73 m 2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 Ϯ 11 months.RESULTS -The mean MDRD e-GFR (41.3 Ϯ 13.1 ml/min per 1.73 m 2 ) did not significantly differ from the i-GFR (45.6 Ϯ 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 Ϯ 27 vs. 160 Ϯ 71 mol/l, P Ͻ 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic retinopathy, and their HDL cholesterol and hemoglobin were higher (P Ͻ 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric: 10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P Ͻ 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the AER increased in the microalbuminuric patients (P Ͻ 0.05), and the sCr increased in the macroalbuminuric patients (P Ͻ 0.01).CONCLUSIONS -Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR below 60 ml/min per 1.73 m 2 do really have a GFR below 60 ml/min per 1.73 m 2 . However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or death is lower. Diabetes Care 30:2034-2039, 2007T wenty-five to forty percent of patients with diabetes have kidney damage (1), and diabetes is the first cause of end-stage renal disease in most countries (2). The early detection of chronic kidney disease (CKD) in diabetic patients is therefore of critical importance. The conventional approach for screening is the determination of the albumin excretion rate (AER). However, a substantial proportion of normoalbuminuric diabetic patients may present with a reduced glomerular filtration rate (GFR): their rates have been reported to be ϳ20% based on GFR Ͻ60 ml/min per 1.73 m 2 in type 2 diabetes (3) and in type 1 diabetes based on GFR Ͻ90 ml/min per 1.73 m 2 with more advanced glomerular lesions (4). In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6...

show abstract

The Mayo Clinic quadratic equation improves the prediction of glomerular filtration rate in diabetic subjects

Abstract: In diabetic subjects, the MCQ has a similar diagnostic performance to the MDRD, but it does not underestimate normal GFR, which is an important advantage.

Cited by 52 publications

References 20 publications

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

The Clinician and Estimation of Glomerular Filtration Rate by Creatinine-based Formulas

Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension

Normoalbuminuric Renal-Insufficient Diabetic Patients

Contact Info

Product

Resources

About