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      Concordance between estimated glomerular filtration rate using equations and that measured using an imaging method Translated title: Concordancia entre la tasa de filtración glomerular estimada con ecuaciones y aquella medida mediante imágenes

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          ABSTRACT Background: Guidelines recommend estimating glomerular filtration rate (GFR) using creatinine-based equations (CBE). Aim: To evaluate the agreement between GFR measured using radionuclide imaging and estimated using creatinine-based equations. Material and Methods: In 421 patients aged 54 ± 17 years (47% women) GFR was estimated using the MDRD-4, CKD-EPI and the body surface adjusted Cockroft Gault equation. GFR was also measured using a radionuclide imaging method with 99mTc-DTPA. The concordance between estimated and measured GFR was calculated using Lin's concordance coefficient and Bland and Altman plots. Results: Average GFR values obtained with CKD-EPI, MDRD-4, body surface adjusted Cockroft Gault equation and 99mTc-DTPA imaging were 75.9 ± 26.6, 76.3 ± 28.8, 77.1 ± 31.6 and 77.9 ± 28.4 ml/min/1.73 m2, respectively. There was no significant difference in means and 29% of participants had a GFR < 60 ml/min/1.73 m2 by CKD-EPI. The correlation was good between equations, but acceptable when compared with the 99mTc-DTPA imaging. The weighted kappa between CBEs was good, but low when comparing CBEs with measured GFR. The Lin's concordance coefficient between estimated and measured GFR was low. Conclusions: GFR measured by 99mTc-DTPA radionuclide imaging has a low correlation and poor concordance with estimations using CBE.

          Translated abstract

          Antecedentes: Las guías clínicas recomiendan estimar la tasa de filtración glomerular (TFG) usando ecuaciones basadas en la creatinina sérica. Objetivo: Estudiar la concordancia entre la TFG medida usando un método de imágenes usando radioisótopos y aquella estimada con ecuaciones. Material y Métodos: En 421 pacientes de 54 ± 17 años (47% mujeres), la TFG se estimó utilizando las ecuaciones MDRD-4, CKD-EPI y Cockroft Gault ajustada para superficie corporal. La TFG se midió también con una técnica de imágenes usando 99mTc-DTPA. La concordancia entre la estimación y medición se calculó usando el coeficiente de concordancia de Lin y gráficos de Bland y Altman. Resultados: Los promedios de TFG obtenidos con CKD-EPI, MDRD-4, ecuación de Cockroft Gault e imágenes con 99mTc-DTPA fueron 75,9 ± 26,6, 76,3 ± 28,8, 77,1 ± 31,6 y 77,9 ± 28,4 ml/min/1,73 m2, respectivamente. No hubo diferencias significativas en los promedios y el 29% de los participantes tuvo una TFG < 60 ml/min/1,73 m2. La correlación entre las ecuaciones fue buena, pero sólo aceptable cuando se comparó con la medición por imágenes. El kappa ajustado entre las ecuaciones fue adecuado, pero malo cuando se comparó las ecuaciones con la medición por imágenes. El coeficiente de Lin mostró una baja concordancia entre la estimación y medición de TFG. Conclusiones: La concordancia entre la estimación de TFG usando ecuaciones y su medición directa mediante imágenes es baja.

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          Most cited references 30

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          Kdigo 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.

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            Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.

            Glomerular filtration rate (GFR) estimates facilitate detection of chronic kidney disease but require calibration of the serum creatinine assay to the laboratory that developed the equation. The 4-variable equation from the Modification of Diet in Renal Disease (MDRD) Study has been reexpressed for use with a standardized assay. To describe the performance of the revised 4-variable MDRD Study equation and compare it with the performance of the 6-variable MDRD Study and Cockcroft-Gault equations. Comparison of estimated and measured GFR. 15 clinical centers participating in a randomized, controlled trial. 1628 patients with chronic kidney disease participating in the MDRD Study. Serum creatinine levels were calibrated to an assay traceable to isotope-dilution mass spectrometry. Glomerular filtration rate was measured as urinary clearance of 125I-iothalamate. Mean measured GFR was 39.8 mL/min per 1.73 m2 (SD, 21.2). Accuracy and precision of the revised 4-variable equation were similar to those of the original 6-variable equation and better than in the Cockcroft-Gault equation, even when the latter was corrected for bias, with 90%, 91%, 60%, and 83% of estimates within 30% of measured GFR, respectively. Differences between measured and estimated GFR were greater for all equations when the estimated GFR was 60 mL/min per 1.73 m2 or greater. The MDRD Study included few patients with a GFR greater than 90 mL/min per 1.73 m2. Equations were not compared in a separate study sample. The 4-variable MDRD Study equation provides reasonably accurate GFR estimates in patients with chronic kidney disease and a measured GFR of less than 90 mL/min per 1.73 m2. By using the reexpressed MDRD Study equation with the standardized serum creatinine assay, clinical laboratories can report more accurate GFR estimates.
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              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.

              The performance of the Modification of Diet in Renal Disease (MDRD) and the Cockcroft-Gault (CG) equations as compared with measured (125)I-iothalamate GFR (iGFR) was analyzed in patients with chronic kidney disease (CKD) and in potential kidney donors. All outpatients (n = 1285) who underwent an iGFR between 1996 and 2003 were considered for analysis. Of these, 828 patients had CKD and 457 were potential kidney donors. Special emphasis was put on the calibration of the serum creatinine measurements. In CKD patients with GFR <60 ml/min per 1.73 m(2), the MDRD equation performed better than the CG formula with respect to bias (-0.5 versus 3.5 ml/min per 1.73 m(2), respectively) and accuracy within 30% (71 versus 60%, respectively) and 50% (89 versus 77%, respectively). Similar results are reported for 249 CKD patients with diabetes. In the kidney donor group, the MDRD equation significantly underestimated the measured GFR when compared with the CG formula, with a bias of -9.0 versus 1.9 ml/min per 1.73 m(2), respectively (P < 0.01), and both the MDRD and CG equations overestimated the strength of the association of GFR with measured serum creatinine. The present data add further validation of the MDRD equation in outpatients with moderate to advanced kidney disease as well as in those with diabetic nephropathy but suggest that its use is problematic in healthy individuals. This study also emphasizes the complexity of laboratory calibration of serum creatinine measurements, a determining factor when estimating GFR in both healthy individuals and CKD patients with preserved GFR.

                Author and article information

                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                January 2021
                : 149
                : 1
                : 13-21
                Bogotá D.C orgnamePontificia universidad Javeriana orgdiv1Facultad de Medicina Colombia
                Keralty orgnameClínica Universitaria Colombia orgdiv1Nefrología Colombia
                Bogotá D.C orgnameHospital universitario San Ignacio orgdiv1Unidad de Nefrología y Trasplante renal Colombia
                S0034-98872021000100013 S0034-9887(21)14900100013

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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