Related Experiment Video
Updated: Jun 11, 2026
Preparation Of Gushukang (GSK) Granules for In Vivo and In Vitro Experiments
Published on: May 9, 2019
Should we continue to use the Cockcroft-Gault formula?
1Department of Internal Medicine, Bertinot Juel Hospital, Chaumont en Vexin, France. heloumail@yahoo.com
Background/Aims:
Although the National Kidney Disease Education Program recommends use of the modification of diet in renal disease (MDRD) formula to estimate the glomerular filtration rate (GFR), most drug-dosing recommendations and clinical practices employ the Cockcroft-Gault (CG) formula. The quality score of the original MDRD study was better than that of the original CG study, although the imprecision sources were very similar between the formulas. To address whether CG should be abandoned in favour of MDRD in chronic kidney disease (CKD) management, we performed a literature review on the topic.
Methods:
We reviewed 27 articles comparing CG and MDRD in terms of bias, precision, accuracy, and the risk of misclassifying by two CKD stages.
Results:
In the chronic renal disease population, MDRD was more precise, safer and more accurate than CG at predicting the GFR, with two exceptions: CG was clearly superior in CKD patients with a normal serum creatinine (SCr) and results were discordant in patients with advanced renal failure. In diabetic populations with normal and near-normal GFR, the decline in renal function in diabetics was better screened by CG. In diabetics with renal impairment, MDRD is more accurate than CG. In healthy patients, in subjects with normal SCr and in elderly patients, MDRD was not superior. Based on the risk of misclassifying by ≥2 CKD stages, neither formula could be safely applied in diabetic, low body mass index, advanced liver disease, chronic heart failure, or hospitalized patients.
Conclusions:
CG still has an interest in screening the decline in renal function in subjects with normal SCr who are at risk, such as diabetics and stage 1 and 2 CKD patients, as well as healthy subjects enrolled in clinical trials and pharmacokinetic studies. Thus, it may be early to replace CG by MDRD in drug studies. CG still is the better formula in the elderly. Both formulas are not safe in some populations.
Insights
The Modification of Diet in Renal Disease (MDRD) formula is more precise for estimating glomerular filtration rate (GFR) in most chronic kidney disease (CKD) patients than the Cockcroft-Gault (CG) formula, but CG remains useful for specific populations.
Area of Science:
- Nephrology
- Pharmacology
- Clinical Chemistry
Background:
- The Modification of Diet in Renal Disease (MDRD) formula is recommended for estimating glomerular filtration rate (GFR) by the National Kidney Disease Education Program.
- However, the Cockcroft-Gault (CG) formula is widely used in clinical practice and drug-dosing recommendations.
- This review examines the comparative performance of MDRD and CG formulas in chronic kidney disease (CKD) management.
Purpose of the Study:
- To compare the accuracy, precision, and safety of the MDRD and CG formulas for estimating GFR in various patient populations.
- To determine if the CG formula should be replaced by the MDRD formula in CKD management.
- To assess the risk of misclassification of CKD stages by both formulas.
Main Methods:
- A literature review of 27 articles comparing the MDRD and CG formulas was conducted.
- The review focused on bias, precision, accuracy, and the risk of misclassifying patients by two or more CKD stages.
- Analysis included diverse patient groups, such as those with diabetes, normal serum creatinine, advanced renal failure, and the elderly.
Main Results:
- MDRD demonstrated greater precision, safety, and accuracy in predicting GFR for the general chronic renal disease population compared to CG.
- CG showed superiority in CKD patients with normal serum creatinine and in screening renal function decline in diabetic populations with normal to near-normal GFR.
- Both formulas exhibited limitations, with neither being reliably safe for classifying CKD stages in diabetic, low BMI, advanced liver disease, chronic heart failure, or hospitalized patients.
Conclusions:
- The CG formula retains value for screening renal function decline in at-risk individuals, including diabetics and stages 1-2 CKD patients, as well as healthy subjects in clinical trials.
- It may be premature to universally replace CG with MDRD in drug studies, especially considering CG's continued utility in the elderly.
- Neither formula is universally applicable or safe across all patient populations, highlighting the need for careful consideration in clinical practice.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:23Dosage Regimen Designs: Nomograms and Tabulations
01:29Drug Dosing: Infants and Children
01:25Determination of Multiple Dosing Parameters: Loading and Maintenance Doses
02:37Experimental Determination of Chemical Formula
01:24Dosage Regimen: Individualization