The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation provides a better definition of cardiovascular burden associated with CKD than the Modification of Diet in Renal Disease (MDRD) Study formula in subjects with type 2 diabetes (original) (raw)
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BMC Nephrology, 2015
Background: Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function. Methods: In a cross-sectional study, bias (eGFR-mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR >60 ml/min/1.73 m 2 and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m 2 per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years. Results: In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m 2 (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m 2 (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI:-12 ± 1.4 ml/min/1.73 m 2 (p < 0.001) and for MDRD:-11 ± 2.1 ml/min/1.73 m 2 (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/ 1.73 m 2 , respectively. Mean ΔGFR (ml/min/1.73 m 2 per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) Conclusions: Both the CKD-EPI and MDRD equations underestimate reference GFR values >90 ml/min/1.73 m 2 as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.
Medicina Clinica, 2010
Background and objective: The Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation has been proposed as a replacement for the Modification of Diet in Renal Disease (MDRD) equation to estimate the glomerular filtration rate, but this equation has not yet been evaluated in the general population. Patients and methods: Cross-sectional analysis of a random sample of 858 participants from the general population aged 50 -75 years without known kidney disease. The prevalence of low eGFR ( o60 mL/min/ 1.73 m 2 ) was assessed with the MDRD and the CKD-EPI equations in the overall sample and in normoalbuminuric individuals. Results: With the MDRD equation the median eGFRs (interquartile range) in men/women were 63.3(12.2)/ 56.7(9.4) mL/min/1.73 m 2 , and with the CKD-EPI equation 66.6(14.2)/61.3(11.6) mL/min/1.73 m 2 .T h ep r evalence of low eGFR in men/women was 35.2%/68.5% and 25.1%/45.7% with the MDRD and the CKD-EPI equations, respectively. Normoalbuminuric women without risk factors for CKD experienced the most pronounced reduction in the number of cases with low eGFR with the CKD-EPI equation. The prevalence of renal impairment in this subgroup still remained even greater than that in men with diabetes, hypertension, or cardiovascular disease. Conclusions: Compared with the MDRD, the CKD-EPI equation generates a substantial reduction in the prevalence of renal impairment in subjects with diabetes, hypertension, cardiovascular disease, and in subjects without risk factors. The prevalence of renal impairment in normoalbuminuric females may be still overestimated with the CKD-EPI equation.