Accuracy and Limitations of Equations for Predicting the Glomerular Filtration Rate during Follow-up of Patients with Non-diabetic Nephropathies

Guy Rostoker; Pierre Andrivet; Isabelle Pham; Mireille Griuncelli; Serge Adnot

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BMC Nephrology 

In This Article

Background

Rapid and accurate estimation of the glomerular filtation rate (GFR) is required for many major clinical decisions in patients with chronic nephropathies.[1] Direct GFR measurement is time-consuming and expensive, frequently requires urine collection and isotope use, and is routinely available in only a few medical centers.[1] In clinical practice, GFR is usually estimated from the serum creatinine concentration. However, this last is affected by factors other than creatinine glomerular filtration, such as diet, muscle mass, tubular secretion, unstable renal function, colorimetric interference, and day-to-day assay variability.[1] To circumvent these limitations, several equations have been developed to estimate GFR from the serum creatinine concentration adjusted for age, sex, body weight and demographic factors.[1] The equation proposed by Cockcroft and Gault in 1976 is widely used throughout the world.[2,3] Adjustment for body surface area has been shown to improve the accuracy of the original Cockcroft-Gault equation.[4] In recent years, the Modification of Diet in Renal Disease (MDRD) group developed three multiple regression models that improved the prediction of GFR from the plasma creatinine concentration.[5] The first includes urinary urea excretion and the second is derived from demographic factors combined with serum creatinine, urea and albumin; the third, which is slightly less accurate, uses demographic factors and serum creatinine (MDRD abbreviated equation).[5] Finally, the Mayo Clinic team have developed a quadratic equation (MCQ) based on results of both healthy subjects and patients with chronic renal diseases.[6]

The validity of these creatinine-based equations for the follow-up of renal function in patients with known renal disease is uncertain, notably during therapeutic interventions and data on this topic are scarce.[7] Indeed, five studies, all restricted to patients with diabetic nephropathy suggested that, in patients with normal renal function or hyperfiltration (microalbuminuric), prediction equations are not accurate enough to monitor kidney function, whereas in chronic kidney disease (CKD) stages 2 and 3 these equations may be valid.[8–12] The aim of this study was therefore to compare the accuracy of prediction equations (original Cockcroft and Gault equation, Cockcroft and Gault equation adjusted for body surface area, Abbreviated MDRD and Mayo Clinic Quadratic Equation) for the follow-up of non-diabetic nephropathies, by comparison with inulin clearance, the gold standard for GFR estimation. We analyzed data from a prospective cohort of 260 European patients with non-diabetic chronic kidney disease,[4] 126 of whom had repeated measures of their GFR based on inulin clearance during their long-term follow-up.

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