Tags

Type your tag names separated by a space and hit enter

Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure.
Clin Nephrol. 2005 Oct; 64(4):271-80.CN

Abstract

BACKGROUND

Estimations of glomerular filtration rate (GFR) obtained either by the modification of diet in renal disease study equation (MDRD-GFR) or by classic 24-hour urine collection-based methods (mean of creatinine and urea clearance (Ccr-ur)) are considered to be equivalent in patients with chronic renal failure (CRF). However, the agreement between both methods has been insufficiently studied in patients during the most advanced stages of CRF.

METHODS

We compared 615 estimations of GFR performed by both methods simultaneously in adult (> 18 years) patients with advanced (aCRF) (15 - 30 ml/min/1.73m2) and preterminal (tCRF) (< 15 ml/min/1.73m2) chronic renal failure. We also analyzed the influence of some relevant covariables (demographic characteristics, inflammatory and nutritional markers) with respect to the concordance between both methods.

RESULTS

In aCRF, mean GFR were 19.7 +/- 5.5 (MDRD-GFR) and 19.3 +/- 3.7 ml/min/1.73m2 (Ccr-ur) (mean difference 0.4 ml/min/1.73m2, 95% confidence interval CI -0.3/1.1, p = 0.26), with an intraclass correlation coefficient of 0.46. In tCRF, mean GFR was 12.5 +/- 4.2 and 10.4 +/- 2.7 ml/min/1.73m2, respectively (mean difference 2.1 ml/min/1.73m2, 95% CI 1.7/2.4, p < 0.0005), with an intraclass correlation co-efficient of 0.43. Multivariate analysis identified lean body mass, body mass index, protein nitrogen appearance, proteinuria, gender, age, albumin (aCRF) and prealbumin (tCRF) as variables independently correlated with the difference MDRD-GFR minus Ccr-ur. Lean body mass was by far the strongest predictor of deviations between both methods, both in aCRF (R2 = 0.66, p < 0.0005) and tCRF (R2 = 0.49, p < 0.0005).

CONCLUSIONS

MDRD-GFR and Ccr-ur show an acceptable agreement in advanced stages of chronic renal failure. However, MDRD-GFR produces estimations of GFR systematically higher than those given by the Ccr-ur method, in patients with tCRF. Moreover, this overestimation is particularly marked in some high risk subsets, including elderly patients and those presenting markers of a poor nutritional condition. Until this issue is further clarified, GFR should be estimated using Ccr-ur rather than MDRD-GFR in patients with tCRF, as also in older and malnourished patients with aCRF, as this may represent a more conservative and safer approach at the time of planning initiation of renal replacement therapy.

Authors+Show Affiliations

Division of Nephrology, Hospital Juan Canalejo, A Corunia, Spain.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16240898

Citation

Garcia-Naveiro, R, et al. "Agreement Between Two Routine Methods of Estimation of Glomerular Filtration Rate in Patients With Advanced and Terminal Chronic Renal Failure." Clinical Nephrology, vol. 64, no. 4, 2005, pp. 271-80.
Garcia-Naveiro R, Rodriguez-Carmona A, Pérez-Fontán M. Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure. Clin Nephrol. 2005;64(4):271-80.
Garcia-Naveiro, R., Rodriguez-Carmona, A., & Pérez-Fontán, M. (2005). Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure. Clinical Nephrology, 64(4), 271-80.
Garcia-Naveiro R, Rodriguez-Carmona A, Pérez-Fontán M. Agreement Between Two Routine Methods of Estimation of Glomerular Filtration Rate in Patients With Advanced and Terminal Chronic Renal Failure. Clin Nephrol. 2005;64(4):271-80. PubMed PMID: 16240898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure. AU - Garcia-Naveiro,R, AU - Rodriguez-Carmona,A, AU - Pérez-Fontán,M, PY - 2005/10/26/pubmed PY - 2005/12/24/medline PY - 2005/10/26/entrez SP - 271 EP - 80 JF - Clinical nephrology JO - Clin Nephrol VL - 64 IS - 4 N2 - BACKGROUND: Estimations of glomerular filtration rate (GFR) obtained either by the modification of diet in renal disease study equation (MDRD-GFR) or by classic 24-hour urine collection-based methods (mean of creatinine and urea clearance (Ccr-ur)) are considered to be equivalent in patients with chronic renal failure (CRF). However, the agreement between both methods has been insufficiently studied in patients during the most advanced stages of CRF. METHODS: We compared 615 estimations of GFR performed by both methods simultaneously in adult (> 18 years) patients with advanced (aCRF) (15 - 30 ml/min/1.73m2) and preterminal (tCRF) (< 15 ml/min/1.73m2) chronic renal failure. We also analyzed the influence of some relevant covariables (demographic characteristics, inflammatory and nutritional markers) with respect to the concordance between both methods. RESULTS: In aCRF, mean GFR were 19.7 +/- 5.5 (MDRD-GFR) and 19.3 +/- 3.7 ml/min/1.73m2 (Ccr-ur) (mean difference 0.4 ml/min/1.73m2, 95% confidence interval CI -0.3/1.1, p = 0.26), with an intraclass correlation coefficient of 0.46. In tCRF, mean GFR was 12.5 +/- 4.2 and 10.4 +/- 2.7 ml/min/1.73m2, respectively (mean difference 2.1 ml/min/1.73m2, 95% CI 1.7/2.4, p < 0.0005), with an intraclass correlation co-efficient of 0.43. Multivariate analysis identified lean body mass, body mass index, protein nitrogen appearance, proteinuria, gender, age, albumin (aCRF) and prealbumin (tCRF) as variables independently correlated with the difference MDRD-GFR minus Ccr-ur. Lean body mass was by far the strongest predictor of deviations between both methods, both in aCRF (R2 = 0.66, p < 0.0005) and tCRF (R2 = 0.49, p < 0.0005). CONCLUSIONS: MDRD-GFR and Ccr-ur show an acceptable agreement in advanced stages of chronic renal failure. However, MDRD-GFR produces estimations of GFR systematically higher than those given by the Ccr-ur method, in patients with tCRF. Moreover, this overestimation is particularly marked in some high risk subsets, including elderly patients and those presenting markers of a poor nutritional condition. Until this issue is further clarified, GFR should be estimated using Ccr-ur rather than MDRD-GFR in patients with tCRF, as also in older and malnourished patients with aCRF, as this may represent a more conservative and safer approach at the time of planning initiation of renal replacement therapy. SN - 0301-0430 UR - https://www.unboundmedicine.com/medline/citation/16240898/Agreement_between_two_routine_methods_of_estimation_of_glomerular_filtration_rate_in_patients_with_advanced_and_terminal_chronic_renal_failure_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -