A New Equation to Estimate Glomerular Filtration Rate
Publication: Annals of Internal Medicine
Volume 150, Number 9
Abstract
Background:
Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values.
Objective:
To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Design:
Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates.
Setting:
Research studies and clinical populations (“studies”) with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006.
Participants:
8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16 032 participants in NHANES.
Measurements:
GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age.
Results:
In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m2), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m2), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m2 (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m2, and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%).
Limitation:
The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR.
Conclusion:
The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Primary Funding Source:
National Institute of Diabetes and Digestive and Kidney Diseases.
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Supplemental Material
Appendix Figure 1. Flow chart showing development of the CKD-EPI pooled creatinine database.
Appendix Table 1. Category 1: Studies and Participant Characteristics
Appendix Table 2. Category 2: Studies and Participant Characteristics
Appendix Table 3. Model Families
Appendix Table 4. Definition of Model Types
Appendix Table 5. Forms of Variables and Coefficients in the CKD-EPI and MDRD Study Equations
Appendix Table 6. Comparison of Performance of MDRD Study and CKD-EPI Equations
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Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 150 • Number 9 • 5 May 2009
Pages: 604 - 612
History
Published online: 5 May 2009
Published in issue: 5 May 2009
Keywords
- Adults
- Age groups
- Biochemistry
- Biomarkers
- Chronic kidney disease
- Diet
- Epidemiology
- Glomerular filtration rate
- Hospital medicine
- Kidneys
- Medical ethics, humanities, and education
- Nephrology
- Nutrition
- Population statistics
- Prevention, policy, and public health
- Racial and ethnic issues
- Renal diseases
- Renal physiology
- Renal system
- Research and reporting methods
- Statistical data
- Statistical methods
- Urology
Copyright
© 2009 American College of Physicians.
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A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med.2009;150:604-612. [Epub 5 May 2009]. doi:10.7326/0003-4819-150-9-200905050-00006
A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med.2009;150:604-612. [Epub 5 May 2009]. doi:10.7326/0003-4819-150-9-200905050-00006
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