Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations

Kazunori Murata, Nikola A. Baumann, Amy K. Saenger, Timothy S. Larson, Andrew D Rule, John C Lieske

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed using both CKD and non-CKD patients to potentially replace the Modification of Diet in Renal Disease (MDRD) equation that was derived with only CKD patients. The objective of our study was to compare the accuracy of the MDRD and CKD-EPI equations for estimating GFR in a large group of patients having GFR measurements for diverse clinical indications. Design, setting, participants, and measurements A cross-sectional study was conducted of patients who underwent renal function assessment for clinical purposes by simultaneous measurements of serum creatinine and estimation of GFR using the MDRD and CKD-EPI equations and renal clearance of iothalamate (n = 5238). Results Bias compared with measured GFR (mGFR) varied for each equation depending on clinical presentation. The CKD-EPI equation demonstrated less bias than the MDRD equation in potential kidney donors (-8% versus -18%) and postnephrectomy donors (-7% versus -15%). However, the CKD-EPI equation was slightly more biased than the MDRD equation in native CKD patients (6% versus 3%), kidney recipients (8% versus 1%), and other organ recipients (9% versus 3%). Among potential kidney donors, the CKD-EPI equation had higher specificity than the MDRD equation for detecting an mGFR <60 ml/min per 1.73 m 2 (98% versus 94%) but lower sensitivity (50% versus 70%). Conclusions Clinical presentation influences the estimation of GFR from serum creatinine, and neither the CKD-EPI nor MDRD equation account for this. Use of the CKD-EPI equation misclassifies fewer low-risk patients as having reduced mGFR, although it is also less sensitive for detecting mGFR below specific threshold values used to define CKD stages.

Original languageEnglish (US)
Pages (from-to)1963-1972
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number8
DOIs
StatePublished - Aug 1 2011

Fingerprint

Diet Therapy
Glomerular Filtration Rate
Chronic Renal Insufficiency
Epidemiology
Kidney
Tissue Donors
Creatinine
Iothalamic Acid
Serum

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations. / Murata, Kazunori; Baumann, Nikola A.; Saenger, Amy K.; Larson, Timothy S.; Rule, Andrew D; Lieske, John C.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 8, 01.08.2011, p. 1963-1972.

Research output: Contribution to journalArticle

@article{1284cc1bc49f4630b2d58864a9fba04a,
title = "Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations",
abstract = "Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed using both CKD and non-CKD patients to potentially replace the Modification of Diet in Renal Disease (MDRD) equation that was derived with only CKD patients. The objective of our study was to compare the accuracy of the MDRD and CKD-EPI equations for estimating GFR in a large group of patients having GFR measurements for diverse clinical indications. Design, setting, participants, and measurements A cross-sectional study was conducted of patients who underwent renal function assessment for clinical purposes by simultaneous measurements of serum creatinine and estimation of GFR using the MDRD and CKD-EPI equations and renal clearance of iothalamate (n = 5238). Results Bias compared with measured GFR (mGFR) varied for each equation depending on clinical presentation. The CKD-EPI equation demonstrated less bias than the MDRD equation in potential kidney donors (-8{\%} versus -18{\%}) and postnephrectomy donors (-7{\%} versus -15{\%}). However, the CKD-EPI equation was slightly more biased than the MDRD equation in native CKD patients (6{\%} versus 3{\%}), kidney recipients (8{\%} versus 1{\%}), and other organ recipients (9{\%} versus 3{\%}). Among potential kidney donors, the CKD-EPI equation had higher specificity than the MDRD equation for detecting an mGFR <60 ml/min per 1.73 m 2 (98{\%} versus 94{\%}) but lower sensitivity (50{\%} versus 70{\%}). Conclusions Clinical presentation influences the estimation of GFR from serum creatinine, and neither the CKD-EPI nor MDRD equation account for this. Use of the CKD-EPI equation misclassifies fewer low-risk patients as having reduced mGFR, although it is also less sensitive for detecting mGFR below specific threshold values used to define CKD stages.",
author = "Kazunori Murata and Baumann, {Nikola A.} and Saenger, {Amy K.} and Larson, {Timothy S.} and Rule, {Andrew D} and Lieske, {John C}",
year = "2011",
month = "8",
day = "1",
doi = "10.2215/CJN.02300311",
language = "English (US)",
volume = "6",
pages = "1963--1972",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "8",

}

TY - JOUR

T1 - Relative performance of the MDRD and CKD-EPI equations for estimating glomerular filtration rate among patients with varied clinical presentations

AU - Murata, Kazunori

AU - Baumann, Nikola A.

AU - Saenger, Amy K.

AU - Larson, Timothy S.

AU - Rule, Andrew D

AU - Lieske, John C

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed using both CKD and non-CKD patients to potentially replace the Modification of Diet in Renal Disease (MDRD) equation that was derived with only CKD patients. The objective of our study was to compare the accuracy of the MDRD and CKD-EPI equations for estimating GFR in a large group of patients having GFR measurements for diverse clinical indications. Design, setting, participants, and measurements A cross-sectional study was conducted of patients who underwent renal function assessment for clinical purposes by simultaneous measurements of serum creatinine and estimation of GFR using the MDRD and CKD-EPI equations and renal clearance of iothalamate (n = 5238). Results Bias compared with measured GFR (mGFR) varied for each equation depending on clinical presentation. The CKD-EPI equation demonstrated less bias than the MDRD equation in potential kidney donors (-8% versus -18%) and postnephrectomy donors (-7% versus -15%). However, the CKD-EPI equation was slightly more biased than the MDRD equation in native CKD patients (6% versus 3%), kidney recipients (8% versus 1%), and other organ recipients (9% versus 3%). Among potential kidney donors, the CKD-EPI equation had higher specificity than the MDRD equation for detecting an mGFR <60 ml/min per 1.73 m 2 (98% versus 94%) but lower sensitivity (50% versus 70%). Conclusions Clinical presentation influences the estimation of GFR from serum creatinine, and neither the CKD-EPI nor MDRD equation account for this. Use of the CKD-EPI equation misclassifies fewer low-risk patients as having reduced mGFR, although it is also less sensitive for detecting mGFR below specific threshold values used to define CKD stages.

AB - Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed using both CKD and non-CKD patients to potentially replace the Modification of Diet in Renal Disease (MDRD) equation that was derived with only CKD patients. The objective of our study was to compare the accuracy of the MDRD and CKD-EPI equations for estimating GFR in a large group of patients having GFR measurements for diverse clinical indications. Design, setting, participants, and measurements A cross-sectional study was conducted of patients who underwent renal function assessment for clinical purposes by simultaneous measurements of serum creatinine and estimation of GFR using the MDRD and CKD-EPI equations and renal clearance of iothalamate (n = 5238). Results Bias compared with measured GFR (mGFR) varied for each equation depending on clinical presentation. The CKD-EPI equation demonstrated less bias than the MDRD equation in potential kidney donors (-8% versus -18%) and postnephrectomy donors (-7% versus -15%). However, the CKD-EPI equation was slightly more biased than the MDRD equation in native CKD patients (6% versus 3%), kidney recipients (8% versus 1%), and other organ recipients (9% versus 3%). Among potential kidney donors, the CKD-EPI equation had higher specificity than the MDRD equation for detecting an mGFR <60 ml/min per 1.73 m 2 (98% versus 94%) but lower sensitivity (50% versus 70%). Conclusions Clinical presentation influences the estimation of GFR from serum creatinine, and neither the CKD-EPI nor MDRD equation account for this. Use of the CKD-EPI equation misclassifies fewer low-risk patients as having reduced mGFR, although it is also less sensitive for detecting mGFR below specific threshold values used to define CKD stages.

UR - http://www.scopus.com/inward/record.url?scp=80051554197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80051554197&partnerID=8YFLogxK

U2 - 10.2215/CJN.02300311

DO - 10.2215/CJN.02300311

M3 - Article

VL - 6

SP - 1963

EP - 1972

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 8

ER -