Abstract
BackgroundChronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.AimTo compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification.Design and settingCohort study in primary care in the Thames Valley region of the UK.MethodData were from 485 participants aged >60 years in the Oxford Renal Cohort Study with at least two eGFR tests. The proportion of study participants diagnosed and classified into different CKD stages using one and two positive tests were compared. Prevalence of CKD diagnosis and classification by CKD stage were compared when eGFR was calculated using MDRD and CKD-EPI equations.ResultsParticipants included in the analysis had a mean age of 72.1 (±6.8) years and 57.0% were female. Use of a single screening test overestimated the proportion of people with CKD by around 25% no matter which equation was used, compared with the use of two tests. The mean eGFR was 1.4 ml/min/1.73 m2 (95% CI = 1.1 to 1.6) higher using the CKD-EPI equation compared with the MDRD equation. More patients were diagnosed with CKD when using the MDRD equation, compared with the CKD-EPI equation, once (64% versus 63%, respectively) and twice (39% versus 38%, respectively), and 16 individuals, all of who had CKD stages 2 or 3A with MDRD, were reclassified as having a normal urinary ACR when using the CKD-EPI equation.ConclusionCurrent guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis. A change from MDRD to CKD-EPI equation could result in one in 12 patients with a CKD diagnosis with MDRD no longer having a diagnosis of CKD.
Highlights
Chronic kidney disease (CKD) is a global health problem associated with high levels of morbidity and mortality.[1,2,3] The prevalence of CKD is increasing worldwide,[4] with current estimates being approximately 13% in the general population.[5]
The mean estimated glomerular filtration rate (eGFR) was 1.4 ml/m in/1.73 m2 higher using the CKD-EPI equation compared with the Modification of Diet in Renal Disease (MDRD) equation
Current guidance to use two eGFR measures to diagnose CKD remains appropriate in an older primary care population to avoid overdiagnosis
Summary
Chronic kidney disease (CKD) is a global health problem associated with high levels of morbidity and mortality.[1,2,3] The prevalence of CKD is increasing worldwide,[4] with current estimates being approximately 13% in the general population.[5]. CKD is diagnosed using measures of kidney damage or function, including the increased urinary albumin:creatinine ratio (ACR) or decreased glomerular filtration rate (GFR), usually estimated from serum creatinine levels. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation is the global standard for estimating GFR, previously the Modification of Diet in Renal Disease (MDRD) equation was most commonly used.[9,10] A description of both equations is available from the authors on request. Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations
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