Dimitrios Tsinalis1, Gilbert T Thiel. 1. Clinic for Transplantation Immunology and Nephrology, University Hospital, Basel, Switzerland. tsinalis@gmx.net
Abstract
BACKGROUND: For the estimation of renal function on the basis of serum creatinine, either the Cockcroft-Gault (CG) equation or the MDRD formula is commonly used. Compared to MDRD (using power functions), CG has the advantage of easy calculability at the bedside. MDRD, however, approaches glomerular filtration rate (GFR) more precisely than CG and gives values corrected for a body surface area (BSA) of 1.73 m(2). We wondered whether CG could be adapted to estimate GFR rather than creatinine clearance without losing the advantage of easy calculability. In this prospective study, inulin clearance under well-defined conditions was taken as the gold standard for GFR. METHODS: In 182 living kidney donors, inulin clearance was measured under standardized conditions (protein, salt and water intake, overnight stay) before and after nephrectomy. Together with the serum creatinine level, and demographic and clinical data, 281 measurements of inulin clearance were used to compare the accuracy of different estimation equations. Using stepwise multiple regression, a new set of constants was defined for a CG-like equation in order to estimate GFR. RESULTS: The MDRD equation underestimated GFR by 9%, and the quadratic equation suggested by Rule overestimated GFR by 12.4%. The new CG-like equation, even when calculated with 'mental arithmetic-friendly' rounded parameters, showed significantly less bias (1.2%). The adapted equation is GFR[mL/min] = ((155 - Age[years]) x weight [kg]/serum creatinine [micromol/L]) x 0.85 if female. CONCLUSIONS: We propose the CG-like equation called IB-eGFR (Inulinclearance Based eGFR) to estimate GFR more reliably than MDRD, Rule's equation or the original Cockcroft-Gault equation. As our data represent a Caucasian population, the adapted equation is still to be validated for patients of other ethnicity.
BACKGROUND: For the estimation of renal function on the basis of serum creatinine, either the Cockcroft-Gault (CG) equation or the MDRD formula is commonly used. Compared to MDRD (using power functions), CG has the advantage of easy calculability at the bedside. MDRD, however, approaches glomerular filtration rate (GFR) more precisely than CG and gives values corrected for a body surface area (BSA) of 1.73 m(2). We wondered whether CG could be adapted to estimate GFR rather than creatinine clearance without losing the advantage of easy calculability. In this prospective study, inulin clearance under well-defined conditions was taken as the gold standard for GFR. METHODS: In 182 living kidney donors, inulin clearance was measured under standardized conditions (protein, salt and water intake, overnight stay) before and after nephrectomy. Together with the serum creatinine level, and demographic and clinical data, 281 measurements of inulin clearance were used to compare the accuracy of different estimation equations. Using stepwise multiple regression, a new set of constants was defined for a CG-like equation in order to estimate GFR. RESULTS: The MDRD equation underestimated GFR by 9%, and the quadratic equation suggested by Rule overestimated GFR by 12.4%. The new CG-like equation, even when calculated with 'mental arithmetic-friendly' rounded parameters, showed significantly less bias (1.2%). The adapted equation is GFR[mL/min] = ((155 - Age[years]) x weight [kg]/serum creatinine [micromol/L]) x 0.85 if female. CONCLUSIONS: We propose the CG-like equation called IB-eGFR (Inulinclearance Based eGFR) to estimate GFR more reliably than MDRD, Rule's equation or the original Cockcroft-Gault equation. As our data represent a Caucasian population, the adapted equation is still to be validated for patients of other ethnicity.