Comparison of various creatinine-based estimates of glomerular filtration rate equations in the Malaysian setting

Kidney disease is a worldwide health concern with an increasing mortality in the past 10 years. The Kidney Disease Improving Global Outcomes (KDIGO) guideline advocates the use of estimated glomerular filtration rate equation (eGFR) to estimate renal function. We evaluated the performance of Cockroft Gault (CG), Modified Diet of Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to measured GFR ^99mTc- DTPA taking into account body mass index (BMI) and age group.

This is a cross-sectional study of patients referred for ^99mTc-DTPA scan at the Nuclear Medicine Centre of International Islamic University Malaysia. The record was taken from patients visiting the centre from January 2016 to December 2019.

The mean measured GFR by ^99mTc-DTPA scan was 42.2 ± 20.38 ml/min. These were lower than that estimated by CG, MDRD, and CKD-EPI equations. CKD-EPI had the highest correlation of 0.72, least bias (mean bias of 11.08 ± 23.08) and was more precise (r² = 0.4) as compared to MDRD and CG. In patients < 65 years old, CKD-EPI had the highest correlation; however, MDRD had the least bias and highest accuracy. In terms of BMI, CKD-EPI had the least bias and highest accuracy for BMI >30 and with the highest correlation for all classes of BMI.

CKD-EPI has the best estimation of GFR taking into account the effect of BMI and age. A further study can be done to determine the correlation of estimated GFR equations with different ethnicity in Malaysia.