title: Performance of the Cockcroft-Gault and modification of diet in renal disease equations in estimating GFR in ill hospitalized patients.
abstract: BACKGROUND
  Estimating glomerular filtration rate (GFR) in severely ill inpatients is clinically important for therapeutic interventions and prognosis, but notoriously difficult to do accurately. The Modification of Diet in Renal Disease (MDRD) equation and Cockcroft-Gault (CG) formula are widely used to estimate renal function in sick hospitalized patients; however, neither method has been validated in this setting.
  
  
  METHODS
  Iodine 125-iothalamate clearances (iGFR) performed in 107 sick inpatients with renal dysfunction were compared with estimated GFRs (eGFRs) from the 6- and 4-variable MDRD (MDRD eGFR) and CG (CG eGFR) equations.
  
  
  RESULTS
  Mean serum creatinine (SCr) level was 3.5 +/- 2.0 mg/dL (309 +/- 177 micromol/L), and mean iGFR was 17.1 +/- 17.9 mL/min/1.73 m2 (0.29 +/- 0.30 mL/s/1.73 m2). Six-variable MDRD eGFR was 22.5 +/- 17.4 mL/min/1.73 m2 (0.38 +/- 0.29 mL/s/1.73 m2), 4-variable MDRD eGFR was 23.9 +/- 16.3 mL/min/1.73 m2 (0.40 +/- 0.27 mL/s/1.73 m2), and CG eGFR was 26.0 +/- 17.1 mL/min/1.73 m2 (0.43 +/- 0.29 mL/s/1.73 m2). Blood urea nitrogen (BUN)/SCr ratios greater than 20 were seen in 58% of patients. Overall, the CG and MDRD equations overestimated iGFR, with poor agreement. Overestimation of at least 25% of measured iGFR was seen in 63%, 67%, and 70% of all inpatients when using the 6-variable MDRD, 4-variable MDRD, and CG equations, respectively. Accuracy of eGFR within 50% of measured iGFR was 55% for the 6-variable MDRD equation, 49% for the 4-variable MDRD equation, and 40% for the CG formula. The performance of both methods deteriorated further in patients with a BUN/SCr ratio greater than 20.
  
  
  CONCLUSIONS
  Estimation equations are performed poorly compared with iGFR and are not reliable measures of actual level of function in sick hospitalized patients, especially those with a high BUN/SCr ratio. Although use of the 6-variable MDRD equation provides a better estimation of GFR, it still is unsuitable for clinical application in this population.
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. poggioe@ccf.org
authors.forename: Emilio D
authors.initials: ED
authors.lastname: Poggio
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Nef
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Frederick
authors.initials: F
authors.lastname: Van Lente
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Dennis
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis; D000465:Algorithms; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005189:False Positive Reactions; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007483:Iothalamic Acid / Q000493:pharmacokinetics; D007674:Kidney Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D007483:Iothalamic Acid; D003404:Creatinine