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A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation
- Andrew S. Levey, MD;
- Juan P. Bosch, MD;
- Julia Breyer Lewis, MD;
- Tom Greene, PhD;
- Nancy Rogers, MS;
- David Roth, MD; and
- for the Modification of Diet in Renal Disease Study Group*
Abstract
Background: Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR).
Objective: To develop an equation to predict GFR from serum creatinine concentration and other factors.
Design: Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease.
Patients: 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample.
Methods: The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample.
Results: To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively.
Conclusion: The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.
*For members of the Modification of Diet in Renal Disease Study Group, see N Engl J Med. 1994; 330:877-84.
- Glomerular filtration rate
- Creatinine
- Kidney failure, chronic
- Diet, protein-restricted
- Blood pressure
Article and Author Information
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Presented in part at the Seventh International Congress on Nutrition and Metabolism in Renal Disease, Stockholm, Sweden, 29 May-1 June 1994, and the 30th Annual Meeting of the American Society of Nephrology, San Antonio, Texas, 2-6 November 1997.
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Grant Support: By the National Institute of Diabetes and Digestive and Kidney Diseases and the Health Care Financing Administration.
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Requests for Reprints: Andrew S. Levey, MD, New England Medical Center, 750 Washington Street, Box 391, Boston, MA 02111.
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Current Author Addresses: Dr. Levey: New England Medical Center, 750 Washington Street, Box 391, Boston, MA 02111; e-mail, Andrew.Levey{at}es.nemc.org.
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Dr. Bosch: George Washington University, 901 23rd Street SW, Washington, DC 20037.
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Dr. Lewis and Ms. Rogers: Vanderbilt University Medical Center, 1211 22nd Avenue S, Nashville, TN 37232.
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Dr. Greene: Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
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Dr. Roth: University of Miami Medical Center, 1475 NW 12th Avenue, Miami, FL 33136.
- Copyright ©2004 by the American College of Physicians
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