Journal List > Korean J Lab Med > v.30(6) > 1011701

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Korean J Lab Med. 2010 Dec;30(6):606-615. Korean.
Published online December 02, 2010.  https://doi.org/10.3343/kjlm.2010.30.6.606
Copyright © 2010 The Korean Society for Laboratory Medicine
Evaluation of Various Formulae for Glomerular Filtration Rate Estimation and Proposal of New Formulae for the Korean Population
Chi Hyun Cho, M.D., Kyoung Ho Roh, M.D., Myung Hyun Nam, M.D., Jang Su Kim, M.D., Chae-Seung Lim, M.D., Chang Kyu Lee, M.D., Kap-No Lee, M.D. and Young Kee Kim, M.D.
Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Young Kee Kim, M.D. Department of Laboratory Medicine, Korea University Anam Hospital, 1 Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5784, Fax: +82-2-920-5538, Email: kyoungk@korea.ac.kr
Received March 02, 2010; Revised September 04, 2010; Accepted November 09, 2010.

Abstract

Background

Some researchers have questioned the necessity of adjusting glomerular filtration rate (GFR) by body surface area (BSA). We compared the relationship between estimated GFR (eGFR) and radionuclide GFR (rGFR) with or without BSA adjustment by comparing the results obtained using various formulae with those obtained using 2 new proposed formulae.

Methods

A retrospective study was performed using 204 Korean individuals whose GFR had been estimated by the 99mTc-diethylenetriaminepentaacetic acid method between March 2004 and July 2008. We used the modification of diet in renal disease (MDRD) II formula, Mayo clinic quadratic (MCQ) formula, Cockcroft-Gault (CG) formula, and lean body mass-adjusted CG formula. Two new formulae, skeletal muscle mass index (SMI)-adjusted CG formula and SMI×3.4/SCr, were proposed by us. We analyzed each parameter with Pearson's correlation coefficient and also obtained the bias values.

Results

BSA did not satisfy the fundamental prerequisites of an adjustment factor for rGFR. MDRD II and MCQ GFR estimates demonstrated higher Pearson's correlation coefficient with BSA-unadjusted rGFR than they did with BSA-adjusted rGFR. The other GFR formulae estimates showed better correlation with rGFR and more favorable bias (P<0.001) when both GFR estimates and rGFR values were BSA-unadjusted. SMI-adjusted CG and SMI×3.4/SCr GFR estimates demonstrated correlation with rGFR and bias values similar to those of the MDRD II and CG GFR estimates.

Conclusions

We suggest that absolute, non-corrected GFR and GFR estimate be preferred in daily practice. The absolute, non-corrected GFR and GFR estimate are considered helpful for patients with eGFR≤60 mL/min/1.73 m2. We also recommend the clinical use of the new formulae, SMI-adjusted CG and SMI×3.4/SCr (BSA-unadjusted).

Keywords: Glomerular filtration rate; Formula; Body surface area

Figures


 Fig. 1
The scatter plot of the comparison of BSA-unadjusted 99mTC-DTPA GFR with BSA-adjusted 99mTC-DTPA GFR of all subjects (N=204).
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Fig. 2
Scatter plots: (A) Between CG GFR estimates and 99mTC-DTPA GFR values (BSA-unadjusted) of all subjects. (B) Between CG GFR estimates and 99mTC-DTPA GFR values (BSA-adjusted) of all subjects. (C) Between MDRD GFR estimates and 99mTC-DTPA GFR values (BSA-unadjusted) of all subjects. (D) Between MDRD GFR estimates and 99mTC-DTPA GFR values (BSA-adjusted) of all subjects. (E) Between SMI-adjusted CG GFR estimates and 99mTC-DTPA GFR values (BSA-unadjusted) of all subjects. (F) Between SMI-adjusted CG GFR estimates and 99mTC-DTPA GFR values (BSA-adjusted) of all subjects. (G) Between SMI×3.4/SCr estimates and 99mTC-DTPA GFR values (BSA-unadjusted) of all subjects. (H) Between SMI×3.4/SCr estimates and 99mTC-DTPA GFR values (BSA-adjusted) of all subjects.

Abbreviations: CG, Cockcroft-Gault formula; GFR, glomerular filtration rate; BSA, body surface area; MDRD, modification of diet in renal disease; SMI, skeletal muscle mass index; SCr, serum creatinine.
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Tables


 Table 1
Prediction formulae used in the calculation of GFR
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Table 2
Descriptive statistics (mean±SD) of GFR estimates and rGFR values of all subjects
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Table 3
Descriptive statistics (mean±SD) of GFR estimates and rGFR values of subjects with eGFR≥70 mL/min/1.73 m2
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Table 4
Correlation and bias between GFR estimates and rGFR values of all subjects (N=204)
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Table 5
Correlation and bias between GFR estimates and rGFR values of subjects with eGFR≥70 mL/min/1.73 m2 (N=89)
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References
1. Rule AD, Gussak HM, Pond GR, Bergstralh EJ, Stegall MD, Cosio FG, et al. Measured and estimated GFR in healthy potential kidney donors. Am J Kidney Dis 2004;43:112–119.
2. Fleming JS, Zivanovic MA, Blake GM, Burniston M, Cosgriff PS. Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun 2004;25:759–769.
3. Lamb E, Newman DJ, Price CP. Kidney function tests. In: Burtis CA, Ashwood ER, et al., editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. Philadelphia: Elsevier Saunders; 2006. pp. 818-826.
4. Delanaye P, Radermecker RP, Rorive M, Depas G, Krzesinski JM. Indexing glomerular filtration rate for body surface area in obese patients is misleading: concept and example. Nephrol Dial Transplant 2005;20:2024–2028.
5. Lin J, Knight EL, Hogan ML, Singh AK. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003;14:2573–2580.
6. Bertolatus JA, Goddard L. Evaluation of renal function in potential living kidney donors. Transplantation 2001;71:256–260.
7. Lewis J, Agodoa L, Cheek D, Greene T, Middleton J, O'Connor D, et al. Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis 2001;38:744–753.
8. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999;130:461–470.
9. Bostom AG, Kronenberg F, Ritz E. Predictive performance of renal function equations for patients with chronic kidney disease and normal serum creatinine levels. J Am Soc Nephrol 2002;13:2140–2144.
10. Kaizu Y, Ohkawa S, Kumagai H. Muscle mass index in haemodialysis patients: a comparison of indices obtained by routine clinical examinations. Nephrol Dial Transplant 2002;17:442–448.
11. Zasadny KR, Wahl RL. Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variations with body weight and a method for correction. Radiology 1993;189:847–850.
12. Spencer K. Analytical reviews in clinical biochemistry: the estimation of creatinine. Ann Clin Biochem 1986;23(Pt 1):1–25.
13. Turner ST, Reilly SL. Fallacy of indexing renal and systemic hemodynamic measurements for body surface area. Am J Physiol 1995;268:R978–R988.
14. Watson WS. Body surface area correction in single-sample methods of glomerular filtration rate estimation. Nucl Med Commun 2000;21:121–122.
15. Rigalleau V, Lasseur C, Raffaitin C, Perlemoine C, Barthe N, Chauveau P, et al. The Mayo Clinic quadratic equation improves the prediction of glomerular filtration rate in diabetic subjects. Nephrol Dial Transplant 2007;22:813–818.
16. Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006;52:5–18.
17. Lim WH, Lim EM, McDonald S. Lean body mass-adjusted Cockcroft and Gault formula improves the estimation of glomerular filtration rate in subjects with normal-range serum creatinine. Nephrology (Carlton) 2006;11:250–256.
18. Kim Y, Min WK, Rhew J. Assessment of the accuracy and precision of cystatin C-based GFR estimates and Cr-based GFR estimates in comparison with Cr51-EDTA GFR. Korean J Lab Med 2007;27:34–39.
19. Rule AD, Rodeheffer RJ, Larson TS, Burnett JC Jr, Cosio FG, Turner ST, et al. Limitations of estimating glomerular filtration rate from serum creatinine in the general population. Mayo Clin Proc 2006;81:1427–1434.
20. Tidman M, Sjöström P, Jones I. A Comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008;23:154–160.
21. Zahran A, Qureshi M, Shoker A. Comparison between creatinine and cystatin C-based GFR equations in renal transplantation. Nephrol Dial Transplant 2007;22:2659–2668.
22. Virga G, Gaspari F, Thomaseth K, Cara M, Mastrosimone S, Rossi V. A new equation for estimating renal function using age, body weight and serum creatinine. Nephron Clin Pract 2007;105:c43–c53.
23. Poggio ED, Wang X, Greene T, Van Lente F, Hall PM. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005;16:459–466.
24. Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol 2005;16:763–773.
25. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–612.
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