Kidney function estimating equations: where do we stand?

Abstract

Estimation of the glomerular filtration rate (GFR) is central to the diagnosis, evaluation and management of chronic kidney disease. This review summarizes recent data on the performance of equations using serum creatinine to estimate the GFR, particularly the Modification of Diet in Renal Disease (MDRD) Study equation. During 2005 GFR estimation has received substantial attention with a focus on comparing the MDRD Study equation with the Cockcroft-Gault equation. Several large studies (n>500) have appeared. Most studies discuss creatinine calibration but few were able to standardize measurements. Studies that did calibrate the creatinine had improved performance. Overall, the MDRD Study equation performed well in populations with a low range of GFR and often outperformed the Cockcroft-Gault equation. Both equations have lower precision in high GFR populations, and the MDRD equation under-estimated the GFR in a number of studies. Efforts are underway to develop improved prediction equations by pooling data across many study populations. Equations for estimating the GFR from serum creatinine are useful for systematic staging of chronic kidney disease. The MDRD Study equation and systematic creatinine assay calibration improve the level of precision and accuracy in many settings. GFR estimates are less useful in the normal range of GFR, however, and are sensitive to the population under study.