The practical implications of using standardized estimation equations in calculating the prevalence of chronic kidney disease

Quinn, Michael; Rainey, A.; Cairns, Karen; Marshall, A.H.; Savage, Gerard; Kee, Frank; Maxwell, Alexander P.; Reaney, Elizabeth; Fogarty, Damian

doi:10.1093/ndt/gfm599

Cited by 18 publications

(13 citation statements)

References 20 publications

(21 reference statements)

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“…The NKDEP recommends that clinical laboratories using creatinine methods that have been calibrated to IDMS should use the IDMS-MDRD equation [27]. Several studies have demonstrated that the IDMS-MDRD equation provides better estimates than the MDRD equation [24,30,34]. …”

Section: Discussionmentioning

confidence: 99%

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Yeo¹,

Han²,

Moon

et al. 2009

Nephron Clin Pract

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Background/Aims: Accurate measurement of glomerular filtration rate (GFR) is critical for the management of kidney transplant recipients. Comparison of creatinine and cystatin C in renal transplant recipients gave conflicting results. We aimed to compare the performance of creatinine- and cystatin C-based equations and creatinine clearance in 102 early postoperative Korean renal transplant patients. Methods: We measured ⁵¹Cr-EDTA clearance using a 2-compartment model and considered this the reference GFR. Then, we estimated GFR using 13 creatinine- and 7 cystatin C-based equations. Serum creatinine value was calibrated to isotope-dilution mass spectrometry (IDMS). Results: The mean reference GFR was 76.77 ± 17.01 ml/min/1.73 m². The IDMS-traceable MDRD (IDMS-MDRD) equation had the highest accuracy (94.12 within 30% of the reference; 99.02 within 50% of the reference) with a bias of 0.33 ml/min/1.73 m² and a precision of 12.57 ml/min/1.73 m². The Mayo Clinic equation also performed well (92.16% within 30% of the reference; 99.02% within 50% of the reference; bias: –0.19 ml/min/1.73 m²). As for cystatin C-based equations, the Filler equation had the least bias (0.03 ml/min/1.73 m²) but low accuracy (78.43% within 30% of the reference). Conclusions: We conclude that the IDMS-MDRD equation provided the best estimate of GFR in our early postoperative Korean renal transplant patients.

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Section: Discussionmentioning

confidence: 99%

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Yeo¹,

Han²,

Moon

et al. 2009

Nephron Clin Pract

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“…Improved accuracy of eGFR is obtainable by using isotope dilution mass spectrometry correction especially in the early stages of chronic kidney disease. 16 Non-standardized creatinine measurements from different laboratories may differ systematically by as much as 27 mmol l À1 . 17 A difference of this magnitude would have a large effect on the results of the eGFR equations.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive women with the metabolic syndrome are at risk of renal insufficiency more than men in general population

et al. 2008

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The prevalence of renal insufficiency in hypertensive participants without comorbidities affecting renal function is unknown. The objective of this study was to assess the prevalence and predictors of renal insufficiency in general hypertensive population. We examined 994 hypertensive participants aged 45-70 years without previously diagnosed diabetes, cardiovascular disease or chronic kidney disease. Renal insufficiency was defined as estimated glomerular filtration rate o60 ml min À1 per 1.73 m 2 by the Modification of Diet in Renal Disease formula. The metabolic syndrome was defined according to the International Diabetes Federation and the US National Cholesterol Education Program Third Adult Treatment Panel criteria. Glucose homoeostasis was assessed with an oral glucose tolerance test. The prevalence of renal insufficiency was 6.7% (95% confidence interval (CI) 5.3-8.5). In a multivariate model, the presence of renal insufficiency was predicted by female gender (odds ratio (OR) 3.57 (95% CI 1.90-6.72)), older age (OR 1.13 (95% CI 1.07-1.18)), use of diuretics (OR 2.13 (95% CI 1.19-3.82)) and metabolic syndrome (OR 2.79 (95% CI 1.34-5.79)). Newly diagnosed diabetes or prediabetes did not predict renal insufficiency. The prevalence of renal insufficiency was found to be lower than previously reported in hypertensive general population. Metabolic syndrome, but not newly diagnosed diabetes or prediabetes per se, was strongly associated with renal insufficiency especially in women. Renal insufficiency was also associated with the use of diuretics, but the clinical relevance of this finding needs to be clarified.

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“…In 2009 most UK laboratories were using the '175-constant' formula with an IDMS-aligned serum creatinine assay. It has been shown that there is little inter-laboratory variation at more advanced stages of CKD [7].…”

Section: Ukrr Pre-rrt Study Methodsmentioning

confidence: 99%

Chapter 13: The UK Renal Registry Advanced CKD Study: frequency of incorrect reporting of date of start of RRT

Ford

Fogarty

Steenkamp³

et al. 2010

Nephron Clin Pract

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Background: A preliminary review of the UK Renal Registry (UKRR) pre-RRT study data revealed results suggesting that, for some patients, the date of start of renal replacement therapy (RRT), as reported to the UKRR, was incorrect and often significantly later than the true date of start. A more detailed study then aimed to validate a set of criteria to identify patients with an incorrect start date. Methods: Pre-RRT laboratory data were electronically extracted from 8,810 incident RRT patients from 9 UK renal centres. Any patient with a low urea (<15 mmol/L) at the start of RRT or with a substantial improvement in kidney function (either a fall in urea >10 mmol/L or rise in eGFR >2 ml/ min/1.73 m) within the two months prior to RRT were considered to potentially have an incorrect date of start. In 4 selected centres, the electronic patient records of all patients flagged were reviewed to validate these criteria. Results: Of 8,810 patients, 1,616 (18.3%) were flagged by the identification criteria as having a potentially incorrect date of start of RRT, although a single centre accounted for 41% of the total flagged cohort. Of these flagged patients, 61.7% had been assigned an incorrect date of start of haemodialysis (HD), 5.7% had evidence of acute RRT being given before the reported date of start of HD and 9.2% had evidence of starting peritoneal dialysis exchanges prior to the reported date of start. Of those flagged, 10.7% had a correct date of start of RRT. Conclusions: Accurate reporting of RRT episodes is vital for the analysis of time dependent studies such as survival or time to transplantation. A proportion of patients starting RRT were assigned an incorrect start date. In order to improve the accuracy of this reporting the UK Renal Registry must work with renal centres and clinical staff on improving data input for the start of RRT.

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The practical implications of using standardized estimation equations in calculating the prevalence of chronic kidney disease

Cited by 18 publications

References 20 publications

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Suitability of the IDMS-Traceable MDRD Equation Method to Estimate GFR in Early Postoperative Renal Transplant Recipients

Hypertensive women with the metabolic syndrome are at risk of renal insufficiency more than men in general population

Chapter 13: The UK Renal Registry Advanced CKD Study: frequency of incorrect reporting of date of start of RRT

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