Is estimated glomerular filtration rate superior to serum creatinine in predicting mortality on the waiting list for liver transplantation?

Abstract

Serum creatinine is an important prognostic indicator in patients on the liver transplant waiting-list, being a component of the Model for End Stage Liver Disease (MELD) score. However, creatinine is influenced by age, gender and race, and in this role may disadvantage some individuals. The Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rate (eGFR) takes into account these variables and may be a superior measure of renal function. Our aim was to examine whether the MDRD 4-variable, 5-variable and 6-variable eGFRs are superior to serum creatinine in predicting 3-month waiting-list mortality in patients with end-stage liver disease. This was a retrospective single-centre study of 427 adults listed for first liver transplantation. The median listing MDRD 4-variable, 5-variable and 6-variable eGFR was 69, 71 and 73 ml/min/1.73 m(2) , respectively. The median listing serum creatinine was 89 μm. MDRD 4-variable (P = 0.002), 5-variable (P < 0.001) and 6-variable eGFR (P < 0.001), and serum creatinine (P < 0.001), were all predictors of mortality on the transplant waiting-list. Of the three MDRD equations, the 6-variable eGFR was the better prognostic indicator. The substitution of 6-variable eGFR for serum creatinine did not improve the prognostic accuracy of the MELD (P = 0.825) and UK score for Patients with End-Stage Liver Disease (P = 0.781) scores. In conclusion the MDRD eGFR is comparable, but not superior to serum creatinine, in predicting death within 3 months of listing for liver transplantation.