Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent.

Marlene Tapper,Donovan A Mcgrowder,Adedamola Soyibo,Lowell Dilworth

doi:10.3390/medicines8090048

Marlene Tapper, Donovan A Mcgrowder + Show 2 more

Open Access

https://doi.org/10.3390/medicines8090048

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Abstract

Background: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. Method: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. Results: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (−0.05). Conclusion: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

Highlights

Worldwide, chronic kidney disease (CKD) has been acknowledged as a public health challenge and over the last decade there has being significant increase in both incidence and prevalence in various populations [1]
Our study demonstrated that the cystatin-based equations for patients with stage 1–4 CKD had lower estimated glomerular filtration rate (eGFR) values than creatinine-based equations
It could be recommended as a substitute to provide the best estimate of glomerular filtration rate (GFR) in our population

Summary

Introduction

Chronic kidney disease (CKD) has been acknowledged as a public health challenge and over the last decade there has being significant increase in both incidence and prevalence in various populations [1]. In 2017, GBD Chronic Kidney Disease Collaboration reported that the global mortality of CKD persons was 1.2 million, and the worldwide death rate was 41.5% greater in 2017 compared with 1990 [2]. The limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. Conclusion: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population

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