Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease

Rule, Andrew D.; Larson, Timothy S.; Bergstralh, Erik J.; Slezak, Jeff; Jacobsen, Steven J.; Cosio, Fernando G.

doi:10.7326/0003-4819-141-12-200412210-00009

Cited by 938 publications

(719 citation statements)

References 19 publications

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“…The original and refitted MDRD equations may have limitations for estimating GFR in individuals with normal or near-normal kidney function [36,37]. Our preliminary observations suggest that estimated GFR using the refitted MDRD equation in Japanese diabetic patients is well correlated with values obtained using a quadratic GFR equation, which is reported to perform better than the MDRD equation in healthy individuals [21]. Although the performance of creatinine-based estimation of GFR remains at issue, the disputed factors would affect absolute values most, and are of less importance when assessing individual change in GFR over a long period, which was the main focus of the present study.…”

Section: Discussionmentioning

confidence: 68%

“…GFR was estimated using the following equation, originating from the Modification of Diet in Renal Disease (MDRD) Study group [20], and refitted for Japanese individuals, as recently proposed by the Working Group of Japan Chronic Kidney Disease Initiative: GFR=186×SCr −1.154 ×Age −0.203 ×0.742 (if female)×0.881, where SCr=serum creatinine (unpublished). In a preliminary assessment of 9,312 Japanese diabetic individuals with serum creatinine <177 μmol/l and urinary ACR <300 mg/g creatinine, estimated GFR values using this equation were well-correlated with values obtained using a quadratic GFR equation [21] (r=0.865, p<0.001, Babazono et al, unpublished observations).…”

Section: Methodsmentioning

confidence: 84%

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Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

et al. 2006

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Aims/hypothesis: Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown. Methods: We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55±13 [mean±SD] years of age) with serum creatinine <177 μmol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144±15 g/l), only modest renal impairment (GFR: 74.8±14.5 ml min −1 1.73 m −2 ), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0±0.9 (range: 2.5 to 6.2) years. Results: Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (−3.27 ml min −1 1.73 m −2 year −1 ) than in the third (−2.71 ml min −1 1.73 m −2 year −1 , p=0.024) and highest quartiles (−2.78 ml min −1 1.73 m −2 year −1 , p=0.046). Conclusions/interpretation: Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 84%

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

et al. 2006

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“…The Cockcroft‐Gault population did not include such a varied population, was only developed in hospitalized males, and data regarding whether any patients had CKD were not included. When the abbreviated MDRD formula was applied to CKD patients, the R 2 was 0.79, but in normal patients the R 2 was only 0.19 15. Furthermore, mean percentage error was −6.2% in CKD patients and −29% in healthy patients 15.…”

Section: Discussionmentioning

confidence: 96%

“…When the abbreviated MDRD formula was applied to CKD patients, the R 2 was 0.79, but in normal patients the R 2 was only 0.19 15. Furthermore, mean percentage error was −6.2% in CKD patients and −29% in healthy patients 15. The most recently developed prediction formula for GFR in human patients is the CKD‐EPI formula.…”

Section: Discussionmentioning

confidence: 99%

“…Mean percent error in 25 cats in which the eGFR formula for cats was tested was −13.6%, which, interestingly, is considerably lower than that obtained in some of the studies in humans. An important conclusion from studies in humans that derived prediction equations for GFR4, 15 is that the population in which formulas are developed should represent the target population. Our study addressed this concern by inclusion of normal healthy cats and cats with decreased renal function in development and testing of the equation.…”

Section: Discussionmentioning

confidence: 99%

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Development of an estimated glomerular filtration rate formula in cats

Finch

Syme

Elliott

2018

Veterinary Internal Medicne

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BackgroundEstimated glomerular filtration rate (eGFR) formulas are routinely used in human patients to provide a more accurate evaluation of GFR compared to serum creatinine concentration alone. Similar formulas do not exist for cats.ObjectivesTo validate a prediction formula for eGFR in cats based on adjusting serum creatinine concentration.AnimalsClient‐owned cats with various levels of renal function.MethodsThe study was cross‐sectional. Glomerular filtration rate was determined by iohexol clearance. Variables including signalment, biochemical markers, and noninvasive measurements considered to represent surrogate markers of muscle mass were evaluated with the reciprocal of serum creatinine concentration in a multivariable regression model. The derived eGFR formula was subsequently tested in another group of cats and agreement with GFR assessed.ResultsThe formula was developed in 55 cats. Only a single morphometric measurement (pelvic circumference) along with the reciprocal of serum creatinine concentration (creatinine−1) independently predicted GFR in the final multivariate model. The derived eGFR formula was 0.408 + (243.11 × creatinine−1 [μmol/L]) ‐ (0.014 × pelvic circumference [cm]). When the formula was tested in another 25 cats it was not found to offer any advantage over creatinine−1 alone in its relationship with GFR (eGFR, R 2 = 0.44, P < .001 vs reciprocal of creatinine, R 2 = 0.45, P < .001). Furthermore, agreement between eGFR and GFR was poor.Conclusions and Clinical ImportanceAn eGFR formula for cats that adjusted serum creatinine concentration for a marker of muscle mass was developed. The formula did not provide a reliable estimate of GFR, and therefore, its routine use cannot be recommended.

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Serum Urea Nitrogen, Creatinine, and Estimators of Renal Function

Smith¹,

Shlipak²,

Havranek³

et al. 2006

Arch Intern Med

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Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease

Abstract: The MDRD equation systematically underestimates GFR in healthy persons. A new equation developed with patients who have chronic kidney disease and healthy persons may be a step toward accurately estimating GFR when the diagnosis of chronic kidney disease is unknown.

Cited by 938 publications

References 19 publications

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

Development of an estimated glomerular filtration rate formula in cats

Serum Urea Nitrogen, Creatinine, and Estimators of Renal Function

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