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Comparative Study
. 2008 Sep;3(5):1332-8.
doi: 10.2215/CJN.05631207. Epub 2008 Jul 30.

A comparison of change in measured and estimated glomerular filtration rate in patients with nondiabetic kidney disease

Dawei Xie  1 , Marshall M Joffe, Steven M Brunelli, Gerald Beck, Glenn M Chertow, Jeffrey C Fink, Tom Greene, Chi-yuan Hsu, John W Kusek, Richard Landis, James Lash, Andrew S Levey, Andrew O'Conner, Akinlolu Ojo, Mahboob Rahman, Raymond R Townsend, Hao Wang, Harold I Feldman
Affiliations
Comparative Study

A comparison of change in measured and estimated glomerular filtration rate in patients with nondiabetic kidney disease

Dawei Xie et al. Clin J Am Soc Nephrol. 2008 Sep.

Abstract

Background and objectives: All glomerular filtration rate (GFR) estimating equations have been developed from cross-sectional data. The aims of this study were to examine the concordance between use of measured GFR (mGFR) and estimated GFR (eGFR) in tracking changes in kidney function over time among patients with moderately severe chronic kidney disease.

Design, setting, participants, & measurements: A retrospective cohort study of subjects who had been enrolled in the MDRD Study A and who had two or more contemporaneous assessments of mGFR and eGFR (n = 542; mGFR range, 25 to 55 ml/min per 1.73 m(2)) during the chronic phase (month 4 and afterwards). mGFR was based on urinary iothalamate clearance; eGFR was based on the 4-variable MDRD Study equation. Temporal changes in GFR were assessed by within-subject linear regression of time on GFR.

Results: Median follow-up time for all subjects was 2.6 yr; median number of GFR measurements was six. The eGFR slope tended to underestimate measured decrements in GFR. The absolute value of the difference in mGFR and eGFR slopes was <or=2 ml/min per 1.73 m(2) per yr among 58.3% of subjects; the remainder of subjects had larger absolute differences. Among the 22 variables studied, none predicted a systematic difference between mGFR slope and eGFR slope.

Conclusions: Although eGFR and mGFR exhibited similar relationships to 22 baseline variables, the overall bias seen in the full cohort suggests that clinicians and researchers should exercise caution when interpreting eGFR slope as a marker of progression of kidney disease.

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Figures

Figure 1.
Figure 1.
Intersubject distribution of eGFR slope (left) and mGFR slope (right). All values are expressed as ml/min per 1.73 m2 per yr. Boxes span from 25th to 75th percentile; median is indicated by line within box; whiskers span from 25th percentile minus 1.5 times the interquartile range to the 75th percentile plus 1.5 times the interquartile range. Estimated GFR slope was distributed with mean (SD), 25th percentile, median, 75th percentile of −2.8 (7.1), −4.8, −2.1, 0.2 ml/min/1.73 m2 per yr. Measured GFR slope was distributed with mean (SD), 25th percentile, median, 75th percentile of −3.9 (7.2), −6.0, −2.9, −0.3 ml/min/1.73 m2 per yr.
Figure 2.
Figure 2.
Scatter plot of eGFR slope versus mGFR slope for: (A) all subjects, (B) subjects with less than 2 yr of follow-up, and (C) subjects with greater than two years of follow-up. Panels A and B exclude three outlier points: (−54.3 ml/min per 1.73 m2 per yr, −62.7 ml/min per 1.73 m2 per yr), (−68.4 ml/min per 1.73 m2 per yr, −82.8 ml/min per 1.73 m2 per yr), and (−83.5 ml/min per 1.73 m2 per yr, −65.6 ml/min per 1.73 m2 per yr).
Figure 3.
Figure 3.
Distribution of the intrasubject difference between mGFR slope and eGFR slope.
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References

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