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Classification of chronic kidney disease by estimated glomerular filtration rate
C Marsik1, G Endler, T Gulesserian
1Medical University of Vienna, Vienna, Austria.
Insights
Estimating glomerular filtration rate (eGFR) equations like MDRD and Mayo Clinic show comparable results for advanced kidney disease. However, MDRD equations identify more patients with mild to moderate kidney impairment.
Area of Science:
- Nephrology
- Clinical Chemistry
- Epidemiology
Background:
- Serum creatinine alone is insufficient for assessing kidney function.
- Estimating glomerular filtration rate (eGFR) equations are crucial for accurate kidney function assessment.
- Several eGFR equations have been developed to improve diagnostic accuracy.
Purpose of the Study:
- To compare the performance of three frequently used eGFR equations: abbreviated MDRD, extended MDRD, and Mayo Clinic.
- To evaluate the impact of these equations on classifying kidney function in a large patient cohort.
- To determine the prevalence of different eGFR classes across various age groups.
Main Methods:
- A retrospective analysis of 244,507 patients from Vienna General Hospital.
- Comparison of eGFR values derived from abbreviated MDRD, extended MDRD, and Mayo Clinic equations.
- Classification of patients into K/DOQI eGFR categories.
Main Results:
- A significant increase in eGFR classes four and five (severe impairment) with advanced age was observed.
- Approximately 1% of patients <30 years and 12% of patients ≥80 years had eGFR <30 mL/min/1.73 m².
- All three equations demonstrated comparable results for severe kidney impairment (eGFR classes four and five).
- MDRD equations identified a higher proportion of patients with mild to moderate kidney impairment (eGFR classes two and three).
Conclusions:
- The MDRD equations, particularly the abbreviated formula, classify more patients into eGFR classes two and three compared to the Mayo Clinic equation.
- All tested equations showed similar performance in identifying patients with severe kidney disease (eGFR classes four and five).
- Consideration of equation choice is important for diagnosing chronic kidney disease, especially for mild to moderate stages.
Background:
Serum creatinine concentration alone as a marker of kidney function is inadequate. Thus several equations for estimating glomerular filtration rate (eGFR) have been proposed within the last years.
Patients And Methods:
In our study we compared three frequently used equations, the abbreviated modification of diet in renal disease (MDRD) formula, the extended MDRD formula and the recently proposed Mayo clinic equation in a large patient cohort.
Results:
A total of 244 507 patients attending the Vienna General Hospital were evaluated for their kidney function and three equations for eGFR were compared. The median age of the patients was 51 years (ranging from 18.0 to 102.6 years) with 44.3% males (n = 108 527). We observed a significant increase of patients with eGFR classes four and five (according to Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines) with advanced age. Whereas approximately 1% of patients < 30 years presented with eGFR classes four and five (defined as eGFR < 30 mL min(-1) 1.73 m(-2)), this prevalence increased up to approximately 12% in patients at the age of 80 years or older. All three equations showed comparable results for eGFR classes four and five. The proportion of patients with mild to moderate impairment of kidney function is higher using both MDRD equations.
Conclusions:
The MDRD equations (particularly the abbreviated MDRD formula) result in considerably higher rates of eGFR classes two and three compared to the Mayo Clinic equation, while all three were comparable in classes four and five. This should be considered when eGFR is used in the diagnosis of chronic kidney disease.
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