Impact of glomerular filtration rate estimation formulas on MECKI score performance and prognostic accuracy in heart failure: the MECKI-RENAL study.

Background Appropriate interpretation of kidney function is crucial for the clinical and therapeutic management of heart failure (HF). Chronic kidney disease (CKD), prevalent in HF patients, plays a pivotal role in disease progression and significantly affects prognosis. Glomerular filtration rate (GFR) is a key indicator of renal function, with several estimation formulas routinely used in clinical practice. However, the relative prognostic performance of these formulas and their impact on established prognostic tools like the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score remain underexplored. This study aims to evaluate the prognostic accuracy of six GFR estimation formulas in patients with reduced ejection fraction (HFrEF) and their effect on the MECKI score. Methods We retrospectively analyzed 6,933 patients from the MECKI score database. GFR was estimated using six formulas: the Modification of Diet in Renal Disease (MDRD); the MDRD modified (MDRDm); the Cockcroft-Gault (CG); the CG modified (CGm); the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); and the European Kidney Function Consortium (EKFC). The primary endpoint was the composite of cardiovascular death, left ventricular assist device (LVAD) implantation, and urgent heart transplantation (HTx) at two years. Results Each GFR formula demonstrated moderate prognostic capacity, with AUC values ranging from 0.6271 to 0.6351. The MDRD formula showed slightly better performance. Subgroup analyses revealed minor differences in prognostic accuracy influenced by BMI, LVEF, and serum creatinine, though these were not clinically significant. Severe CKD prevalence, defined as eGFR <30 ml/min/1.73 m², varied modestly across formulas, ranging from 3.2% (MDRD) to 4.5% (EKFC). Despite these variations, incorporating eGFR values from any formula into the MECKI score resulted in stable prognostic performance, with AUC values between 0.7841 and 0.7883. This confirms the robustness of the MECKI score across different GFR estimation methods. Conclusions This study underscores the importance of renal function in HF prognosis and highlights the comparable prognostic accuracy of the six most commonly used eGFR formulas. While minor differences were observed in specific patient subgroups, they were unlikely to influence clinical outcomes. The MECKI score, a comprehensive and validated prognostic tool, retained its predictive power regardless of the GFR formula employed, emphasizing its reliability in risk stratification.

Background Appropriate interpretation of kidney function is essential for clinical and therapeutic management of heart failure (HF). In HF patients, chronic kidney disease plays a critical role and impacts prognosis. In this study we aimed at evaluating the prognostic accuracy of five glomerular filtration rate (GFR) estimation formulas in HF patients with reduced ejection fraction (HFrEF) and their impact on the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score. Methods We retrospectively analyzed 6,933 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database. GFR was estimated using five different formulas: the Modification of Diet in Renal Disease (MDRD); the MRDR modified (MDRDm); the Cockcroft–Gault (CG), the CG modified (CGm); and the Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI). The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation at 2 years. Results Table 1 shows the main characteristics of the population. The median follow–up was 4.2 years (IQR 1.8–7.6). Each GFR estimation demonstrated similar but moderate prognostic capacity (AUC range: 0.6278–0.6351), with the MDRD equation showing the best performance (Figure 1, left). Employment of eGFR according to the 5 different formulas in the MECKI score calculation did not significantly alter its prognostic power (AUC ranging from 0.7841 to 0.7883) (Figure 1, right). Conclusions While GFR estimation methods exhibit moderate prognostic capacity with only slight variations existing in the prognostic performance of different GFR estimation methods, the MECKI score remains a reliable tool for risk prediction in HFrEF, facilitating individualized treatment decisions in HF management. Individualized risk assessment based on patient–specific characteristics should inform clinical decision–making in HF management, warranting further exploration and validation in future studies.in risk stratification.Figure 1

Background: Common variable immunodeficiency (CVID) is the most common primary immunodeficiency in adults. In addition to renal complications of the disease, there may be an increased likelihood of renal dysfunction due to sucrose in immunoglobulin replacement therapies or other drugs used in treatment. In CVID patients, it is important to monitor patients for renal complications at routine intervals. We compared creatinine-based calculation methods for estimated glomerular filtration rate (eGFR) such as Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (CG), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) with 24-hour urine creatinine clearance measurement. We aimed to investigate which calculation method was more reliable and consistent in this patient population. Methods: The records of 14 patients who had clinical follow-up at our hospital were retrospectively reviewed. Patients’ eGFR values were measured by three different methods (CKD-EPI, MDRD , and CG formulas). The 24-hour urinary creatinine clearance of all patients and e-GFR calculated by the formula were compared. Results: The eGFR calculated using the MDRD formula was 122.99±41.22 mL/min/1.73 m2, whereas the eGFR measured using the 24-hour urinary creatinine clearance was 99.64(83.35-156.58) mL/min/1.73 m2. Moreover, eGFR calculated by CKD-EPI formula was 113.83±26.46 mL/min/1.73 m2, while eGFR calculated by CG formula was 133.52±45.35 mL/min/1.73 m2. 24-hour urinary creatinine clearance was positively correlated with MDRD, CKD-EPI and CG formulas (r=0.726, p=0.003, r=0.634, p=0.015, r=0.806, p=0.001, respectively). Conclusions: We found that all creatinine-based formulas used in clinical practice for eGFR measurement correlate with 24-hour urine creatinine clearance in patients with CVID. In addition, we have shown that eGFR calculated with the formula CKD-EPI is more closely related to 24-hour urinary creatinine clearance. Therefore, we believe that the eGFR measurement calculated with CKD-EPI is more useful for nephrological follow-up of patients with CVID. It should be noted that our study has some limitations due to the small number of patients.

An Endorsement of the Removal of Race From GFR Estimation Equations: A Position Statement From the National Kidney Foundation Kidney Disease Outcomes Quality Initiative

BackgroundThe most commonly used glomerular filtration rate estimating equations for drug dosing are Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. However there is still a concern about whether to use MDRD and CKD-EPI interchangeably with CG for drug dosage adjustment.MethodsThe study was initiated to determine the concordance between MDRD, CKD-EPI and CG equations and associated factors in patients with chronic kidney disease at Saint Paul’s Hospital Millennium Medical College (SPHMMC). This was a cross sectional study which involved patient chart review and physicians self-administered questionnaire. Serum creatinine level ≥ 1.2 mg/dL was used as a cutoff point in pre-selection of patients. The correctness of the drug dose prescribed for the level of renal function were compared to the drug database (Lexi-Comp) available through Up-to-date version 21.2.ResultsAmong the total of 422 patients, 249 (59%) were males. Mean age of patients was 46.09 years. The use of MDRD equation for drug dose adjustment by physicians working in the renal clinic of SPHMMC was six out of nine physicians. The Pearson correlation coefficient between the CG with MDRD and CKD-EPI equations was r = 0.94, P < 0.001 and r = 0.95, P < 0.001, respectively. The concordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories was 73.7%, Kappa = 0.644 and 74.9%, Kappa = 0.659, respectively. Concordance between the CG with MDRD and CKD-EPI equations for the drug dosing recommendation was 89.6%, kappa = 0.782 and 92%, kappa = 0.834, respectively. Age > 70 years was associated with discordance between CG and MDRD equations for drug dosing recommendation whereas serum creatinine 1.2–3.5 mg/dL, weight < 61 Kg and age > 70 years were associated with discordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories. However, none of the factors associated with discordance between CG and CKD-EPI for drug dosing.ConclusionMDRD equation can be used interchangeably with CG equation for drug dosing recommended in all adult patients between the age of 18 and 70 years. CKD-EPI can be used interchangeably with CG in all adult Ethiopian patients with CKD.

Estimation of GFR: A Comparison of New and Established Equations

The importance of glomerular filtration rate (GFR) estimating equations in the care of hospitalized patients

To evaluate the results of 24-hour urinary creatinine clearance (CrCl) with estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI Pakistan (CKD-EPI Pak), Cockcroft Gault (CG) and 4-variable Modification of Diet in Renal Disease (MDRD) equations. Descriptive, cross-sectional study. Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, from June to October 2013. Laboratory data of subjects ≥18 years ordering 24-hour urinary CrCl from June to October 2013 was retrieved. Statistical comparison of eGFR using CKD-EPI, CKD-EPI Pak, CG and MDRD with the timed urine collection CrCl was done using regression analysis. The mean age of the group (n=670) was 51.3 ±15.4 years with a median of 53 (IQR:22.3) years, 55.7% being males. Median BMI of males and females was 26.98 kg/m2(IQR: 7.09) and 26.16 kg/m2(IQR: 6.97), respectively. Mean GFR using 24-hour creatinine clearance was 57.1 ±35.9 ml/min/1.73m2 with a median of 51 ml/min/1.73m2. Urinary creatinine clearance showed strong correlation with CG, MDRD, CKD-EPI and CKD-EPI Pak, showing r=0.78, r=0.79, r=0.82, and r=0.82, respectively. Sensitivity was highest for the CKD-EPI Pakistan (84.7%). Similarly, CKD-EPI Pakistan equation showed the highest agreement (88.7%) with CrCl compared to the other formulae. The CKD-EPI Pak equation is more accurate and precise than the CG, CKD-EPI and MDRD in estimating GFR in Pakistani population.

Background: Creatin clirens test (CCT) is a reliable examination to estimate LFG. To solve some weaknesses in the creatinine clirens test, we can use estimation of glomerulus filtration rate (eLFG). Estimation of glomerulus filtration rate (eLFG) can be used as the Cockcroft Gault (CG) formula, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Each formula has advantages and disadvantages. Objective: The aim of this study was to compare the results of CCT with eLFG (CG, MDRD, CKD-EPI) and the correlation between results of CCT and eLFG (CG, MDRD, CKD-EPI). Method: Research on the comparison of the results of creatinine clarity test (CCT) and estimation of glomerulus filtration rate (eLFG) is a type of comparative analytical study with a retrospective approach. Result: The results showed that there were no differences in the results of CCT and eLFG (CG, MDRD, CKD-EPI) (p &gt; 0.05). In addition, there is correlation between CCT and eLFG (CG, MDRD, CKD-EPI) (r &gt; 0.05). Conclusion: It can be concluded that there is no difference in the results of CCT and eLFG (CG, MDRD, CKD-EPI). In addition, there is a correlation between the results of CCT and eLFG (CG, MDRD, CKD-EPI).

Overcoming Vestiges of Structural Racism in Kidney Care and Renal Nutrition and Revisiting Cockcroft-Gault Creatinine Clearance and Its Weight Index

Background: The glomerular filtration rate (GFR) is considered the gold standard for assessing renal function. According to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, GFR estimation is often carried out using predictive equations that incorporate serum creatinine levels, along with demographic factors such as age, gender, race, and body size. However, these equations exhibit varying levels of accuracy across different populations, necessitating the evaluation of their performance and clinical relevance in diverse patient groups.Objectives: This study aimed to evaluate the performance of three commonly used GFR estimation equations, the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, along with their race-modified versions, by comparing them with measured 24-hour creatinine clearance (CrCl) in adult patients with chronic kidney disease (CKD).Methods: A cross-sectional descriptive study was conducted at Jos University Teaching Hospital (JUTH) between November 2019 and July 2020, involving 111 consecutively recruited CKD patients. Data collection included medical history, physical examination, laboratory investigations, calculation of CrCl, estimated glomerular filtration rate (eGFR) using different equations, and albumin-creatinine ratio (ACR). Statistical analysis was performed using SPSS version 20 (IBM Inc., Armonk, New York), with p-values <0.05 considered statistically significant.Results: The mean age of participants was 51.1±15.5 years. Diabetes mellitus was the most common cause of CKD, affecting 38% of the cohort. Among participants, 31% and 22% were classified as having stage 5 and stage 4 CKD, respectively. The median CrCl was 26 (9-56) mL/min. The median eGFR values across the equations were as follows: CG, 26 (11-60) mL/min/1.73m²; MDRD, 26 (11-60) mL/min/1.73m²; MDRD1, 22 (9-50) mL/min/1.73m²; CKD-EPI, 26 (10-62) mL/min/1.73m²; and CKD-EPI1, 22 (9-53) mL/min/1.73m². Strong positive correlations were observed between measured CrCl and the estimated GFR from each equation: CG (r=0.948, p=0.001), MDRD (r=0.940, p=0.001), MDRD1 (r=0.939, p=0.001), CKD-EPI (r=0.943, p=0.001), and CKD-EPI1 (r=0.942, p=0.001). Furthermore, significant correlations were found between the different GFR equations themselves, with the highest correlation observed between MDRD and CKD-EPI (r=0.999, p=0.001). The median ACR was 395.5 (45.3-2887.0) mg/g, and albuminuria was present in 82% of participants. All three GFR equations closely approximated the measured CrCl of 26 mL/min/1.73m². The equations performed optimally in patients with GFR values below 45 mL/min, with the CG equation exhibiting the least bias and the highest precision. Regression analysis revealed a significant association between albuminuria and all GFR equations and a notable association between age and CrCl, CG, and CKD-EPI estimates.Conclusion: The CG, MDRD, and CKD-EPI equations demonstrated comparable accuracy to measured 24-hour CrCl in estimating GFR in Nigerian patients with CKD. These findings support the clinical use of these predictive equations for renal function assessment in CKD, though local validation in diverse populations is recommended for optimal clinical application.

Comparison of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study Equations and A Formula Based on Cystatin-C and Serum Creatinine for the Estimation of Glomerular Filtration Rate in Patients with Multiple Myeloma; Is It Time to Change From MDRD to CKD-EPI Equation?

Correlation of methods of glomerular filtration rate estimation: Cockcroft–gault equation, modification of diet in renal disease, chronic kidney disease epidemiology collaboration, and DTPA renography in prospective renal donors -a retrospective analytical study

Renal dysfunction is common in HIV-positive patients, and guidelines suggest regular monitoring of renal function with estimated glomerular filtration rate (eGFR) and urinalysis. It is unknown whether Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) or Modification of Diet in Renal Disease (MDRD) provide better estimates of glomerular filtration rate (GFR) in this population. We compared the CKD-EPI and MDRD equations to estimate GFR at baseline in 20,132 HIV-positive individuals in the UK CHIC cohort. Kappa statistics and Bland-Altman plots were used to assess agreement between the two estimates and Kaplan-Meier plots and Cox regression analysis to describe mortality patterns. At baseline, median eGFR was 100 (87, 112) (CKD-EPI) and 94 (83, 108) (MDRD) (mL/min/1.73 m(2)). Good overall agreement between CKD-EPI- and MDRD-defined eGFR bands was observed (Kappa = 0.71, 95% confidence interval: 0.70-0.72). Of the 367 patients with eGFR MDRD 30-59, 57 (15.5%) were categorized as eGFR 60-89 by CKD-EPI. After adjustment for covariates, eGFR <60 (CKD-EPI), eGFR <30 (MDRD) and eGFR ≥105 (both formulae) were significantly associated with an increased risk of death. Mortality in patients classified as having eGFR 60-89 by CKD-EPI and eGFR 30-59 by MDRD more closely resembled mortality of patients who had eGFR 60-89 by both formulae. MDRD and CKD-EPI equations showed a high degree of agreement in stratifying patients by baseline eGFR. CKD-EPI estimates of GFR <60 at baseline are more strongly associated with mortality than MDRD estimates of GFR <60, supporting the concept that MDRD may have overestimated the severity of renal impairment in these patients. Our findings support the use of CKD-EPI in HIV-positive individuals.

To assess which of the formulae for estimating renal function (Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration CKD-EPI) and Modification of Diet in Renal Disease (MDRD)) provides the most accurate prediction of minimum vancomycin concentration (Cmin) and to evaluate whether they can be interchanged to optimise vancomycin dosage. An observational and retrospective study was undertaken in hospitalised adult patients treated with intravenous vancomycin. Patients with serum creatinine (Scr) >2 mg/dL and <0.5 mg/dL, body mass index >40 kg/m2, need for extracorporeal clearance techniques and unstable renal function were excluded. Bayesian analysis was used to obtain individual pharmacokinetic parameters. Vancomycin clearance (CLvan) was calculated by means of CG (eCLvanCG), CKD-EPI (eCLvanCKD-EPI) and MDRD (eCLvanMDRD) and used to obtain Cmin estimates (eCmin). eCmin and observed Cmin were compared using an intraclass correlation coefficient (ICC). A post-hoc analysis by subgroups (age, sex, weight, Scr and estimated glomerular filtration rate (eGFR)) was performed. From each eCLvan, the area under the curve (AUC) was calculated and categorised as AUC <400 mg*hour/L, AUC 400-600 mg*hour/L and AUC >600 mg*hour/L. The kappa coefficient was applied to study AUC concordance. A total of 228 patients (69.3% men) were included. eCminCG had a statistically significant better agreement with Cmin (ICC >0.7) and showed good agreement in almost all subgroups. Patients with Scr >1.1 mg/dL were the only subgroup in which eCminMDRD and eCminCKD-EPI had an adequate ICC with no statistically significant differences compared with eCminCG. eCminMDRD had a similar ICC to eCminCG in the eGFR <60 mL/min and age 46-75 years subgroups. Kappa values showed regular agreement in all subgroups: 0.32 (AUC <400 mg*hour/L), 0.24 (AUC 400-600 mg*hour/L) and 0.41 (AUC >600 mg*hour/L). The CG formula provides the most accurate prediction of vancomycin Cmin. In patients with eGFR <60 mL/min and aged 46-75 years, MDRD also shows a good predictive capacity. However, in low weight and elderly patients, Cmin predictions are superior with CG. Therefore, renal function estimation equations should not be considered interchangeable for vancomycin dose adjustments.