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.
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.
Authors: Andrew D Rule; Timothy S Larson; Erik J Bergstralh; Jeff M Slezak; Steven J Jacobsen; Fernando G Cosio Journal: Ann Intern Med Date: 2004-12-21 Impact factor: 25.391
Authors: Lesley A Stevens; Christopher H Schmid; Yaping L Zhang; Josef Coresh; Jane Manzi; Richard Landis; Omran Bakoush; Gabriel Contreras; Saul Genuth; Goran B Klintmalm; Emilio Poggio; Peter Rossing; Andrew D Rule; Matthew R Weir; John Kusek; Tom Greene; Andrew S Levey Journal: Nephrol Dial Transplant Date: 2009-09-30 Impact factor: 5.992
Authors: Andrew S Levey; Josef Coresh; Tom Greene; Lesley A Stevens; Yaping Lucy Zhang; Stephen Hendriksen; John W Kusek; Frederick Van Lente Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Andrew D Rule; Richard J Rodeheffer; Timothy S Larson; John C Burnett; Fernando G Cosio; Stephen T Turner; Steven J Jacobsen Journal: Mayo Clin Proc Date: 2006-11 Impact factor: 7.616
Authors: Brian R Lane; Sevag Demirjian; Christopher J Weight; Benjamin T Larson; Emilio D Poggio; Steven C Campbell Journal: J Urol Date: 2010-01-18 Impact factor: 7.450
Authors: Lesley A Stevens; Jane Manzi; Andrew S Levey; Jing Chen; Amy E Deysher; Tom Greene; Emilio D Poggio; Christopher H Schmid; Michael W Steffes; Yaping Lucy Zhang; Frederick Van Lente; Josef Coresh Journal: Am J Kidney Dis Date: 2007-07 Impact factor: 8.860
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Harini A Chakkera; Aleksandar Denic; Walter K Kremers; Mark D Stegall; Joseph J Larson; Harish Ravipati; Sandra J Taler; John C Lieske; Lilach O Lerman; Joshua J Augustine; Andrew D Rule Journal: Nephrol Dial Transplant Date: 2020-06-01 Impact factor: 5.992