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Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population.
Scand J Urol Nephrol. 2012 Jun; 46(3):212-22.SJ

Abstract

OBJECTIVE

The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations.

MATERIAL AND METHODS

The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P(10)) and ± 30% (P(30)) of measured GFR, and classification ability for five GFR stages (<15, 15-29, 30-59, 60-89 and ≥90 ml/min/1.73 m(2)) were compared.

RESULTS

Overall, all three equations performed satisfactorily: LM Revised, MDRD, CKD-EPI showed, respectively, a median bias of -5.8%, -2.2% and 1.7%, IQR 11.9, 12.3 and 11.7 ml/min/1.73 m(2), P(10) 35%, 34% and 38%, P(30) 84%, 79% and 79% and correctly classified GFR stages 68%, 65% and 69%. LM Revised was at least as accurate in terms of P(30) as the other equations at GFR intervals <90, while CKD-EPI was the only unbiased and the most accurate equation at ≥90 ml/min/1.73 m(2). LM Revised was more stable in terms of bias and accuracy across age and BMI groups than MDRD and CKD-EPI. Both MDRD and CKD-EPI overestimated measured GFR among elderly patients and in the small group of underweight men.

CONCLUSION

The ideal all-purpose GFR prediction equation does not exist. LM Revised should be preferred in patients with suspected or known renal insufficiency, while CKD-EPI is most useful in settings where patients with no a priori suspicion of renal impairment are evaluated. Differences in creatinine measurements between laboratories may limit the generalizability of the present validation.

Authors+Show Affiliations

Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

22250974

Citation

Björk, Jonas, et al. "Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Equations to Estimate Glomerular Filtration Rate in a Large Swedish Clinical Population." Scandinavian Journal of Urology and Nephrology, vol. 46, no. 3, 2012, pp. 212-22.
Björk J, Jones I, Nyman U, et al. Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population. Scand J Urol Nephrol. 2012;46(3):212-22.
Björk, J., Jones, I., Nyman, U., & Sjöström, P. (2012). Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population. Scandinavian Journal of Urology and Nephrology, 46(3), 212-22. https://doi.org/10.3109/00365599.2011.644859
Björk J, et al. Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Equations to Estimate Glomerular Filtration Rate in a Large Swedish Clinical Population. Scand J Urol Nephrol. 2012;46(3):212-22. PubMed PMID: 22250974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population. AU - Björk,Jonas, AU - Jones,Ian, AU - Nyman,Ulf, AU - Sjöström,Per, Y1 - 2012/01/18/ PY - 2012/1/19/entrez PY - 2012/1/19/pubmed PY - 2012/9/1/medline SP - 212 EP - 22 JF - Scandinavian journal of urology and nephrology JO - Scand J Urol Nephrol VL - 46 IS - 3 N2 - OBJECTIVE: The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations. MATERIAL AND METHODS: The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P(10)) and ± 30% (P(30)) of measured GFR, and classification ability for five GFR stages (<15, 15-29, 30-59, 60-89 and ≥90 ml/min/1.73 m(2)) were compared. RESULTS: Overall, all three equations performed satisfactorily: LM Revised, MDRD, CKD-EPI showed, respectively, a median bias of -5.8%, -2.2% and 1.7%, IQR 11.9, 12.3 and 11.7 ml/min/1.73 m(2), P(10) 35%, 34% and 38%, P(30) 84%, 79% and 79% and correctly classified GFR stages 68%, 65% and 69%. LM Revised was at least as accurate in terms of P(30) as the other equations at GFR intervals <90, while CKD-EPI was the only unbiased and the most accurate equation at ≥90 ml/min/1.73 m(2). LM Revised was more stable in terms of bias and accuracy across age and BMI groups than MDRD and CKD-EPI. Both MDRD and CKD-EPI overestimated measured GFR among elderly patients and in the small group of underweight men. CONCLUSION: The ideal all-purpose GFR prediction equation does not exist. LM Revised should be preferred in patients with suspected or known renal insufficiency, while CKD-EPI is most useful in settings where patients with no a priori suspicion of renal impairment are evaluated. Differences in creatinine measurements between laboratories may limit the generalizability of the present validation. SN - 1651-2065 UR - https://www.unboundmedicine.com/medline/citation/22250974/Validation_of_the_Lund_Malmö_Chronic_Kidney_Disease_Epidemiology__CKD_EPI__and_Modification_of_Diet_in_Renal_Disease__MDRD__equations_to_estimate_glomerular_filtration_rate_in_a_large_Swedish_clinical_population_ DB - PRIME DP - Unbound Medicine ER -