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- Title
Estimation of Glomerular Filtration Rate in Older Patients with Chronic Renal Insufficiency: Is the Modification of Diet in Renal Disease Formula an Improvement?
- Authors
Lamb, Edmund J.; Webb, Michelle C.; Simpson, David E.; Coakley, Anthony J.; Newman, David J.; O'Riordan, Shelagh E.
- Abstract
OBJECTIVES: To evaluate a new formula for glomerular filtration rate (GFR), derived from the Modification of Diet in Renal Disease (MDRD) study in older people. DESIGN: An observational study of the performance of the MDRD formula compared with other formulae and creatinine clearance (ClCr) as measures of the GFR. SETTING: Volunteers were recruited via outpatient clinics. PARTICIPANTS: Fifty-two patients (27 men, 25 women: mean age 80, range 69-92) with a variety of medical diagnoses. Mean GFR was 53.3 mL/min/1.73 m[SUP2] (range 15.9-100.2). Exclusion criteria included renal replacement therapy/renal transplantation and cognitive impairment. MEASUREMENTS: [SUP51]Chromium ethylenediaminetetraacetic acid ([SUP51]Cr EDTA) was used as the reference method against which the formulaic estimates of GFR were compared using bias plot and regression analyses. RESULTS: The MDRD and Cockcroft and Gault formulae (both coefficient of determination (R[SUP2]) = 0.84) gave the best fit with GFR, followed by the Jelliffe formula (R[SUP2] = 0.81), ClCr (R[SUP2] = 0.73) and the Baracskay formula (R[SUP2] = 0.56). ClCr (-1.2%) demonstrated minimal bias compared with the MDRD (8.0%) and Cockcroft and Gault (-10.4%) formulae. However, imprecision compared with [SUP51]Cr EDTA was lowest for the Cockcroft and Gault formula, with 50% of estimates lying between -9.5 and -0.5 mL/min/1.73 m[SUP2] of measured [SUP51] Cr EDTA clearance. This compares with 36.7 and 10.1 mL/min/1.73 m[SUP2] for ClCr and 0.0 and 12.7 mL/min/1.73 m[SUP2] for the MDRD formula. CONCLUSION: Calculated estimates of GFR are an improvement over ClCr estimation. On balance, the MDRD formula does not improve the estimate of GFR compared with the Cockcroft and Gault formula in older Caucasian patients with chronic renal insufficiency.
- Subjects
CHRONIC kidney failure; GLOMERULAR filtration rate; KIDNEY function tests; KIDNEY diseases; CHRONIC diseases
- Publication
Journal of the American Geriatrics Society, 2003, Vol 51, Issue 7, p1012
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1046/j.1365-2389.2003.51330.x