Keywords
MDRD-IDMS
glomerular filtration rate
chronic kidney disease
biological variability
How to Cite
Abstract
Introduction: The measurement of the glomerular filtration rate, or its estimation through the use of validated equations such as MDRD-IDMS and CKD-EPI, allows patients to be categorized into the different stages of chronic kidney disease (CKD). However, the change from the MDRD-IDMS equation to the CKD-EPI equation requires statistical and clinical analysis. The tolerable Total Error and the acceptable Systematic Error for this estimate can be calculated through the Biological Variability concept. The objective of this study was to compare the estimated values of glomerular filtration by using the CKD-EPI equation versus the MDRD-IMDS equation in a cohort of patients with different stages of CKD and to perform an analysis based on the significance of the statistical differences and clinics. Materials and Methods: 4986 outpatient data were evaluated. The
differences between both equations were studied against the desirable Systematic Error. Results: CKD-EPI
reclassified patients in stages different from those of the MDRD-IDMS equation, mainly in stages 1 and 2. When performing the analysis in the female cohort, the differences were statistically and clinically significant in all stages, except in G5. However, in males, the differences were statistically significant in all stages, but clinically
not significant in stages 3B, 4 and 5. Conclusions: The equations can categorize patients in different stages.
Therefore, the use of a different equation to determine the CKD stage can modify the recommendations and
therapeutic decisions mainly in the female population.
References
Gracia S, Montañés R, Bover J, Cases A, Deulofeu R, Martín de Francisco AL et al. Recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en adultos. Nefrologia. 2006;26(6):658-65.
Fraga A. Evaluación del filtrado glomerular en nefropatía por diabetes. Nefrol Argent. 2010; 8(Supl. 1):21-6
Stevens LA, Levey AS, Measure S. GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol 2009; 20: 2305-2313.
Inserra F, Angerosa M, Alegre JR, Alles A, Bianchi ME, Dorado E et al. Documento de Consenso. Implicancia de la proteinuria en el diagnóstico y seguimiento de la enfermedad renal crónica (ERC). Rev Nefrol Dial Traspl. 2013; 33(4):233-48.
Levey AS, Bosch JP, Lewis JB, Green T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.
Pérez Loredo J, Lavorato CA, Negri AL. Tasa de filtración glomerular medida y estimada. Numerosos métodos de medición (Parte I). Rev Nefrol Dial Traspl. 2015; 35(3):153-64.
Stevens LA, Coresh J, Feldman HI, Greene T, Lash JP, Nelson RG, et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol. 2007; 18(10):2749-57.
Vervoort G., Willems H.L., Wetzels J.F. Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: Validity of a new (MDRD) prediction equation. Nephrol Dial Transplant. 2002; 17:1909–13
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145(4):247-54
Pottel H, Martens F. Are eGFR equations better than IDMS-traceable serum creatinine in classifying chronic kidney disease? Scand J Clin Lab Invest. 2009; 69(5):550-61
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604- 12.
Montañés Bermúdez R, Bover Sanjuán J, Oliver Samper A, et al. Valoración de la nueva ecuación CKD-EPI para la estimación del filtrado glomerular. Nefrología 2010; 30:185-94
KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements - Official Journal of the International Society of Nephrology. 2013; 3 (1).
Pérez-Loredo J, Lavorato CA, Negri AL, Der M, Lercari J, Casaliba A. Comparación gráfica de ecuaciones de estimación del filtrado glomerular. Rev Nefrol Diálisis Traspl 2011; 31(1):34-43.
Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K. Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med. 2012; 156(11):785-95.
Vilche Juárez AM, Fares Taie S, Bollati M, Correa V. Evaluación de la estimación de la tasa de filtrado glomerular en pacientes diabéticos utilizando ecuaciones basadas en creatinina y en cistatina C. Rev Bioq Patol Clin. 2017;81(1):19-26
Salvador-González B, Rodríguez-Latre LM, Güell-Miró R, Álvarez-Funes V, et al. . Estimation of glomerular filtration rate by MDRD-4 IDMS and CKD-EPI in individuals of 60 years of age or older in primary care. Nefrologia. 2013; 33:552–563.
Rowe C, Sitch AJ, Barratt J, Brettell EA, Cockwell P, Dalton RN, et al. Biological variation of measured and estimated glomerular filtration rate in patients with chronic kidney disease. Kidney Int. 2019; 96(2):429- 35.
Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb). 2015 Jun 5;25(2):141-51.
Sandberg S, Fraser CG, Horvath AR, Jansen R, Jones G, Oosterhuis W, et al. Defining analytical performance specifications: Consensus Statement from the 1st Strategic Conference of the European Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med. 2015; 53(6):833-35.
Jones GRD, Albarede S, Kesseler D, MacKenzie F, Mammen J, et al. Analytical performance specifications for external quality assessment - definitions and descriptions. Clin Chem Lab Med. 2017; 27;55(7):949-55.
European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), 2019, https://biologicalvariation.eu/meta_calculations 23. Inserra F, Torres ML, Alles A, Bonelli C, Ceci R, Corradino C, et al. Documento multidisciplinario de consenso 2021. Evaluación de la función renal para la detección y seguimiento de la enfermedad renal crónica. ByPC ene-abr 2022: 86(1):56-80.