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GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease.
Nephrol Dial Transplant. 2005 Nov; 20(11):2394-401.ND

Abstract

BACKGROUND

Although prediction equations are recommended to determine GFR and creatinine clearance (CrCl), neither the MDRD equations nor the Cockcroft and Gault formula have been validated for the low levels of GFR present in end-stage renal disease (ESRD). The accuracy of the MDRD equations and the Cockcroft and Gault formula in predicting GFR and CrCl, respectively, was examined in patients with ESRD and its relationship to the basal GFR and two markers of malnutrition, urinary creatinine and body fat determined.

METHODS

Inulin clearance (C(in)) was measured in 26 non-diabetic patients with ESRD and the 24 h CrCl determined. GFR was predicted using three equations derived from the MDRD study population containing four to six variables. Both CrCl and GFR were predicted from the Cockcroft and Gault formula. Estimates of bias and precision were obtained and Bland and Altman analysis performed. Body fat was measured by DEXA scan.

RESULTS

The predicted GFR (MDRD) was 10% lower than C(in) (8.83+/-0.71 ml/min/1.73 m2) with all three MDRD equations, showing a similar degree of precision and bias. C(in) gave a negative correlation with the difference between the predicted GFR (MDRD) and the measured GFR. The predicted GFR (MDRD) underestimated GFR when C(in) >8 ml/min/1.73 m2 but overestimated GFR when C(in) <8 ml/min/1.73 m2. The Cockcroft and Gault formula overestimated CrCl by 14% and overestimated C(in) by 35%. C(in) gave a negative correlation with the difference between the predicted GFR (Cockcroft and Gault) and measured GFR, overestimating GFR when C(in) <13 ml/min/1.73 m2. The overestimation of GFR by the MDRD equation was not associated with urinary creatinine excretion. However, both Cockcroft and Gault and the MDRD predictions showed a positive, but weak, correlation with body fat.

CONCLUSION

The MDRD equations were more accurate in predicting the group mean GFR in patients with ESRD than the Cockcroft and Gault formula. However, the predicted GFR using either formula was related to the basal GFR and percentage body fat.

Authors+Show Affiliations

Sheffield Kidney Institute, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16115853

Citation

Kuan, Ying, et al. "GFR Prediction Using the MDRD and Cockcroft and Gault Equations in Patients With End-stage Renal Disease." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 20, no. 11, 2005, pp. 2394-401.
Kuan Y, Hossain M, Surman J, et al. GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease. Nephrol Dial Transplant. 2005;20(11):2394-401.
Kuan, Y., Hossain, M., Surman, J., El Nahas, A. M., & Haylor, J. (2005). GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 20(11), 2394-401.
Kuan Y, et al. GFR Prediction Using the MDRD and Cockcroft and Gault Equations in Patients With End-stage Renal Disease. Nephrol Dial Transplant. 2005;20(11):2394-401. PubMed PMID: 16115853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease. AU - Kuan,Ying, AU - Hossain,Mohammad, AU - Surman,Joanne, AU - El Nahas,A Meguid, AU - Haylor,John, Y1 - 2005/08/22/ PY - 2005/8/24/pubmed PY - 2006/1/13/medline PY - 2005/8/24/entrez SP - 2394 EP - 401 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 20 IS - 11 N2 - BACKGROUND: Although prediction equations are recommended to determine GFR and creatinine clearance (CrCl), neither the MDRD equations nor the Cockcroft and Gault formula have been validated for the low levels of GFR present in end-stage renal disease (ESRD). The accuracy of the MDRD equations and the Cockcroft and Gault formula in predicting GFR and CrCl, respectively, was examined in patients with ESRD and its relationship to the basal GFR and two markers of malnutrition, urinary creatinine and body fat determined. METHODS: Inulin clearance (C(in)) was measured in 26 non-diabetic patients with ESRD and the 24 h CrCl determined. GFR was predicted using three equations derived from the MDRD study population containing four to six variables. Both CrCl and GFR were predicted from the Cockcroft and Gault formula. Estimates of bias and precision were obtained and Bland and Altman analysis performed. Body fat was measured by DEXA scan. RESULTS: The predicted GFR (MDRD) was 10% lower than C(in) (8.83+/-0.71 ml/min/1.73 m2) with all three MDRD equations, showing a similar degree of precision and bias. C(in) gave a negative correlation with the difference between the predicted GFR (MDRD) and the measured GFR. The predicted GFR (MDRD) underestimated GFR when C(in) >8 ml/min/1.73 m2 but overestimated GFR when C(in) <8 ml/min/1.73 m2. The Cockcroft and Gault formula overestimated CrCl by 14% and overestimated C(in) by 35%. C(in) gave a negative correlation with the difference between the predicted GFR (Cockcroft and Gault) and measured GFR, overestimating GFR when C(in) <13 ml/min/1.73 m2. The overestimation of GFR by the MDRD equation was not associated with urinary creatinine excretion. However, both Cockcroft and Gault and the MDRD predictions showed a positive, but weak, correlation with body fat. CONCLUSION: The MDRD equations were more accurate in predicting the group mean GFR in patients with ESRD than the Cockcroft and Gault formula. However, the predicted GFR using either formula was related to the basal GFR and percentage body fat. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/16115853/GFR_prediction_using_the_MDRD_and_Cockcroft_and_Gault_equations_in_patients_with_end_stage_renal_disease_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfi076 DB - PRIME DP - Unbound Medicine ER -