Comparison of MDRD, CKD-EPI, and Cockcroft-Gault equation in relation to measured glomerular filtration rate among a large cohort with diabetes

• Published in: Journal of diabetes and its complications Vol. 31; no. 9; pp. 1376 - 1383
• Main Authors: Schwandt, Anke, Denkinger, Michael, Fasching, Peter, Pfeifer, Martin, Wagner, Christian, Weiland, Jörg, Zeyfang, Andrej, Holl, Reinhard W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017; Elsevier Limited
• Subjects: Accuracy; Adolescent; Adult; Age; Aged; Aged, 80 and over; Bias; Body mass index; Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Clinical Trials as Topic - statistics & numerical data; Cockcroft-Gault (CG); Cohort Studies; Diabetes; Diabetes type 1; Diabetes type 2; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - diet therapy; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - physiopathology; Epidemiologic Studies; Epidemiology; Estimates; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerular filtration rate (GFR); Humans; Hypertension; Kidney diseases; Kidney Function Tests - methods; Male; Middle Aged; Models, Theoretical; Modification of Diet in Renal Disease (MDRD); Patients; Predictive Value of Tests; Public health; Registries; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - diet therapy; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Sensitivity and Specificity; Severity of Illness Index; Urine; Young Adult; Cockcroft-Gault (CG); Glomerular filtration rate (GFR); Modification of Diet in Renal Disease (MDRD); Diabetes type 1; Diabetes type 2; Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.06.016

To analyze the performance of Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault (CG), and CG calculated with ideal bodyweight (CG-IBW) equations to estimate glomerular filtration rate (eGFR) based on serum creatinine in a large diabetic population. 24,516 adults with type-1-diabetes or type-2-diabetes from the multicenter diabetes prospective follow-up registry DPV were analyzed. We compared eGFR and measured GFR (mGFR) based on 24-h urine collection by calculating mean bias (difference), precision (SD of this difference), accuracy (proportion of eGFR within ±10% of mGFR), Bland-Altman-plots. CG overestimates, whereas MDRD, CKD-EPI, and CG-IBW underestimate. Smallest mean bias and highest accuracy (75.3%) were observed for MDRD compared to the other equations (p<0.0001). MDRD and CKD-EPI estimated most accurately in stages 1 (MDRD:57.7%, CKD-EPI:57.3%) and 2 (MDRD:80.2%, CKD-EPI:80.7%). In stages 3 to 5, highest accuracy was observed for the MDRD (stage 3:82.3%, stage 4:77.8%, stage 5:71.0%). Among younger subjects, accuracy was higher using the CKD-EPI (18–<40years:63.7%, 40–<60years:72.8%). Above age 60years, MDRD estimated most accurately (60–<70years:77.3%, ≥70years:78.8%). In males and females, MDRD estimated most accurately (males:75.3%, females:75.3%). In this large diabetic cohort, smallest bias and highest accuracy were observed for the MDRD.