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ARTICLE

Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease

Andrew D. Rule, MD; Timothy S. Larson, MD; Erik J. Bergstralh, MSc; Jeff M. Slezak, MSc; Steven J. Jacobsen, MD, PhD; and Fernando G. Cosio, MD

21 December 2004 | Volume 141 Issue 12 | Pages 929-937

Background: The National Kidney Foundation has advocated the use of the abbreviated Modification of Diet in Renal Disease (MDRD) equation to estimate glomerular filtration rate (GFR) from serum creatinine measurements in clinical laboratories. However, healthy persons were not included in the development of the MDRD equation.

Objectives: To assess the accuracy of the MDRD equation in patients with chronic kidney disease compared with healthy persons and to develop a new equation that uses both patients with chronic kidney disease and healthy persons.

Design: Cross-sectional study.

Setting: The Mayo Clinic, a tertiary-care medical center.

Participants: Consecutive patients (n = 320) who had an iothalamate clearance test specifically for chronic kidney disease evaluation and consecutive healthy persons (n = 580) who had an iothalamate clearance test specifically for kidney donor evaluation.

Measurements: Serum creatinine levels, GFR, demographic characteristics, and clinical characteristics were abstracted from the medical record.

Results: The MDRD equation underestimated GFR by 6.2% in patients with chronic kidney disease and by 29% in healthy persons. Re-estimated coefficients for serum creatinine and sex were similar to the original MDRD equation in the chronic kidney disease series but not in the healthy series. At the same serum creatinine level, age, and sex, GFR was on average 26% higher in healthy persons than in patients with chronic kidney disease (P < 0.001). A quadratic GFR equation was developed to estimate logarithmic GFR from the following covariates: 1/SCr, 1/SCr², age, and sex (where SCr = serum creatinine).

Limitations: The new equation was not developed in a general population sample. Elderly and African-American persons were underrepresented.

Conclusion: The MDRD equation systematically underestimates GFR in healthy persons. A new equation developed with patients who have chronic kidney disease and healthy persons may be a step toward accurately estimating GFR when the diagnosis of chronic kidney disease is unknown.

Editors' Notes Context Experts increasingly use the Modification of Diet in Renal Disease (MDRD) equation to estimate glomerular filtration rate (GFR). Contribution This cross-sectional study compared GFR estimated by the MDRD equation with GFR measured by iothalamate clearance in 320 patients with chronic kidney disease and 580 healthy kidney donor candidates. The MDRD equation underestimated GFR by 6% in patients with kidney disease and by 29% in healthy persons. The authors also derived a quadratic equation that better estimated GFR in the healthy people than did the MDRD equation. Implications The MDRD equation systematically underestimates GFR and may erroneously categorize some healthy persons as having kidney disease. –The Editors

 

Author and Article Information

From Mayo Clinic, Rochester, Minnesota.

Acknowledgments: The authors thank Timothy Uphoff, PhD, and Mary Burritt, PhD, for technical support on laboratory measurements.

Grant Support: By a National Research Service Award (T32 DK07013) and grants from the Division of Nephrology, Mayo Clinic, Rochester, Minnesota.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Fernando G. Cosio, MD, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; e-mail, Cosio.Fernando{at}mayo.edu.

Author Contributions: Conception and design: A.D. Rule, T.S. Larson, E.J. Bergstralh, F.G. Cosio.

Analysis and interpretation of the data: A.D. Rule, T.S. Larson, E.J. Bergstralh, J.M. Slezak, S.J. Jacobsen, F.G. Cosio.

Drafting of the article: A.D. Rule, S.J. Jacobsen, F.G. Cosio.

Critical revision of the article for important intellectual content: A.D. Rule, T.S. Larson, F.G. Casio.E.J. Bergstralh, J.M. Slezak, S.J. Jacobsen, F.G. Cosio.

Final approval of the article: A.D. Rule, T.S. Larson, S.J. Jacobsen, F.G. Cosio.

Provision of study materials or patients: T.S. Larson, F.G. Cosio.

Statistical expertise: A.D. Rule, E.J. Bergstralh, J.M. Slezak, S.J. Jacobsen.

Obtaining of funding: A.D. Rule, F.G. Cosio.

Administrative, technical, or logistic support: F.G. Cosio.

Collection and assembly of data: A.D. Rule, T.S. Larson, J.M. Slezak, F.G. Cosio.

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