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Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population.

Björk, Jonas LU ; Jones, Ian; Nyman, Ulf LU and Sjöström, Per (2012) In Scandinavian journal of urology and nephrology 46(3). p.212-222
Abstract
Abstract Objective. The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations. Material and methods. The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P (10)) and ± 30% (P (30)) of measured GFR, and classification ability for five GFR stages (<15, 15-29, 30-59,... (More)
Abstract Objective. The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations. Material and methods. The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P (10)) and ± 30% (P (30)) of measured GFR, and classification ability for five GFR stages (<15, 15-29, 30-59, 60-89 and ≥90 ml/min/1.73 m(2)) were compared. Results. Overall, all three equations performed satisfactorily: LM Revised, MDRD, CKD-EPI showed, respectively, a median bias of -5.8%, -2.2% and 1.7%, IQR 11.9, 12.3 and 11.7 ml/min/1.73 m(2), P (10) 35%, 34% and 38%, P (30) 84%, 79% and 79% and correctly classified GFR stages 68%, 65% and 69%. LM Revised was at least as accurate in terms of P (30) as the other equations at GFR intervals <90, while CKD-EPI was the only unbiased and the most accurate equation at ≥90 ml/min/1.73 m(2). LM Revised was more stable in terms of bias and accuracy across age and BMI groups than MDRD and CKD-EPI. Both MDRD and CKD-EPI overestimated measured GFR among elderly patients and in the small group of underweight men. Conclusion. The ideal all-purpose GFR prediction equation does not exist. LM Revised should be preferred in patients with suspected or known renal insufficiency, while CKD-EPI is most useful in settings where patients with no a priori suspicion of renal impairment are evaluated. Differences in creatinine measurements between laboratories may limit the generalizability of the present validation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian journal of urology and nephrology
volume
46
issue
3
pages
212 - 222
publisher
Taylor & Francis
external identifiers
  • WOS:000304102900008
  • PMID:22250974
  • Scopus:84861088109
ISSN
1651-2065
DOI
10.3109/00365599.2011.644859
language
English
LU publication?
yes
id
6dc1523f-221d-400f-ba56-aa0a8c653e66 (old id 2336322)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22250974?dopt=Abstract
date added to LUP
2012-02-01 21:38:45
date last changed
2016-11-18 11:24:00
@misc{6dc1523f-221d-400f-ba56-aa0a8c653e66,
  abstract     = {Abstract Objective. The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations. Material and methods. The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P (10)) and ± 30% (P (30)) of measured GFR, and classification ability for five GFR stages (&lt;15, 15-29, 30-59, 60-89 and ≥90 ml/min/1.73 m(2)) were compared. Results. Overall, all three equations performed satisfactorily: LM Revised, MDRD, CKD-EPI showed, respectively, a median bias of -5.8%, -2.2% and 1.7%, IQR 11.9, 12.3 and 11.7 ml/min/1.73 m(2), P (10) 35%, 34% and 38%, P (30) 84%, 79% and 79% and correctly classified GFR stages 68%, 65% and 69%. LM Revised was at least as accurate in terms of P (30) as the other equations at GFR intervals &lt;90, while CKD-EPI was the only unbiased and the most accurate equation at ≥90 ml/min/1.73 m(2). LM Revised was more stable in terms of bias and accuracy across age and BMI groups than MDRD and CKD-EPI. Both MDRD and CKD-EPI overestimated measured GFR among elderly patients and in the small group of underweight men. Conclusion. The ideal all-purpose GFR prediction equation does not exist. LM Revised should be preferred in patients with suspected or known renal insufficiency, while CKD-EPI is most useful in settings where patients with no a priori suspicion of renal impairment are evaluated. Differences in creatinine measurements between laboratories may limit the generalizability of the present validation.},
  author       = {Björk, Jonas and Jones, Ian and Nyman, Ulf and Sjöström, Per},
  issn         = {1651-2065},
  language     = {eng},
  number       = {3},
  pages        = {212--222},
  publisher    = {ARRAY(0xb4aeac0)},
  series       = {Scandinavian journal of urology and nephrology},
  title        = {Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population.},
  url          = {http://dx.doi.org/10.3109/00365599.2011.644859},
  volume       = {46},
  year         = {2012},
}