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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
Contribution
Implications
–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. ARTICLE
Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease
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K. Wattanakit, A. R. Folsom, E. Selvin, J. Coresh, A. T. Hirsch, and B. D. Weatherley Kidney Function and Risk of Peripheral Arterial Disease: Results from the Atherosclerosis Risk in Communities (ARIC) Study J. Am. Soc. Nephrol., February 1, 2007; 18(2): 629 - 636. [Abstract] [Full Text] [PDF]
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J. H. Ix, M. G. Shlipak, G. M. Chertow, and M. A. Whooley Association of Cystatin C With Mortality, Cardiovascular Events, and Incident Heart Failure Among Persons With Coronary Heart Disease: Data From the Heart and Soul Study Circulation, January 16, 2007; 115(2): 173 - 179. [Abstract] [Full Text] [PDF]
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L. F. Fried, M. L. Biggs, M. G. Shlipak, S. Seliger, B. Kestenbaum, C. Stehman-Breen, M. Sarnak, D. Siscovick, T. Harris, J. Cauley, et al. Association of Kidney Function with Incident Hip Fracture in Older Adults J. Am. Soc. Nephrol., January 1, 2007; 18(1): 282 - 286. [Abstract] [Full Text] [PDF]
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J. Iglesias, D. Hom, M. Antoniotti, S. Ayoub, and J. S. Levine Predictors of worsening renal function in adult patients with congestive heart failure receiving recombinant human B-type brain natriuretic peptide (nesiritide) Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3458 - 3465. [Abstract] [Full Text] [PDF]
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G. Placha, G. D. Poznik, J. Dunn, A. Smiles, B. Krolewski, T. Glew, S. Puppala, J. Schneider, J. J. Rogus, S. S. Rich, et al. A Genome-Wide Linkage Scan for Genes Controlling Variation in Renal Function Estimated by Serum Cystatin C Levels in Extended Families With Type 2 Diabetes Diabetes, December 1, 2006; 55(12): 3358 - 3365. [Abstract] [Full Text] [PDF]
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P. M. Rainey Automatic Reporting of Estimated Glomerular Filtration Rate--Jumping the Gun? Clin. Chem., December 1, 2006; 52(12): 2184 - 2187. [Full Text] [PDF]
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A. S. Levey, L. A. Stevens, and T. Hostetter Automatic Reporting of Estimated Glomerular Filtration Rate--Just What the Doctor Ordered Clin. Chem., December 1, 2006; 52(12): 2188 - 2193. [Full Text] [PDF]
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J. Redon, F. Morales-Olivas, A. Galgo, M. A. Brito, J. Mediavilla, R. Marin, P. Rodriguez, S. Tranche, J. V. Lozano, C. Filozof, et al. Urinary Albumin Excretion and Glomerular Filtration Rate across the Spectrum of Glucose Abnormalities in Essential Hypertension J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S236 - S245. [Abstract] [Full Text] [PDF]
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A. S. Go, W. Y. Lee, J. Yang, J. C. Lo, and J. H. Gurwitz Statin therapy and risks for death and hospitalization in chronic heart failure. JAMA, November 1, 2006; 296(17): 2105 - 2111. [Abstract] [Full Text] [PDF]
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C. J. Diskin Creatinine and GFR: an imperfect marriage of convenience Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3338 - 3339. [Full Text] [PDF]
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P.J. Twomey and T.M. Reynolds The MDRD formula and validation QJM, November 1, 2006; 99(11): 804 - 805. [Full Text] [PDF]
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B. Kiberd The Chronic Kidney Disease Epidemic: Stepping Back and Looking Forward J. Am. Soc. Nephrol., November 1, 2006; 17(11): 2967 - 2973. [Abstract] [Full Text] [PDF]
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G. L. Schwartz and S. C. Textor Early Referral for Chronic Kidney Disease: Good for Those Who Need It, but Who Are They? Mayo Clin. Proc., November 1, 2006; 81(11): 1420 - 1422. [Full Text] [PDF]
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A. D. Rule, R. J. Rodeheffer, T. S. Larson, J. C. Burnett Jr, F. G. Cosio, S. T. Turner, and S. J. Jacobsen Limitations of Estimating Glomerular Filtration Rate From Serum Creatinine in the General Population Mayo Clin. Proc., November 1, 2006; 81(11): 1427 - 1434. [Abstract] [Full Text] [PDF]
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