Document Detail

Inaccuracies in estimated glomerular filtration rate (eGFR) in one Australian renal centre.
MedLine Citation:
PMID:  21352419     Owner:  NLM     Status:  Publisher    
Background:  Early identification of true renal disease (GFR < 60mL/min) results in better patient outcomes. There is now routine reporting in Australia of estimated GFR (eGFR) in all patients over age 18 who have serum creatinine measured, calculated by the MDRD formula which was validated in an American Caucasian cohort. Significant clinical decisions and prognosis are often made on the basis of this calculation. Aim:  To assess the accuracy of three estimates of GFR in an Australian population by comparing eGFR obtained by the abbreviated aMDRD, Cockcroft Gault corrected for body surface area(BSA) (CG), and CKD-Epi formulae with a gold standard, isotopic (51) Cr EDTA GFR. Method:  Patients referred with eGFR < 60mL/min reported by the aMDRD formula underwent isotopic measurement of GFR (over four hours) and had eGFR calculated using CG corrected for BSA, aMDRD and CKD-Epi formulae. Data were analysed using Bland-Altman plots and regression analysis to compare methods; bias, precision and the proportion of patients correctly stratified by stage of chronic kidney disease (CKD) was also compared according to the three estimates of GFR, using (51) Cr EDTA GFR as the gold standard. Results:  139 patients were recruited (female 45%), mean age 64years and mean serum creatinine 212umol/L. The mean GFR (SD) (ml/min/m(2) ) for isotopic, CG, aMDRD and CKD-Epi were 47(28), 37(20), 32(17) and 33(18); P = 0.001 for aMDRD and CKD-Epi. CG (57%) was more likely to correctly stage CKD than aMDRD (37%) or CKD-Epi (37%) and absolute bias was significantly lower using CG than either other method (p = 0.001). Conclusion:  In this small Australian population the CG formula corrected for BSA agreed more closely with isotopic GFR and correctly staged patients with CKD more often than the aMDRD or CKD-Epi formulae. It is important that each renal Unit considers the accuracy of estimates of GFR according to their population demographics.
Brown Mark A; Pirabhahar Saiyini; Kelly John J; Mangos George J; Mackenzie Callie; McConachie Peter; Janssen Julia; Smart Richard C
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-25
Journal Detail:
Title:  Nephrology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1797     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology.
Department of Renal Medicine and Medicine and Depart of Nuclear Medicine St George Hospital and University of New South Wales Australia.
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