title: Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft-Gault equation in screening for impaired kidney function in Japanese Americans.
abstract: The Cockcroft-Gault and the Modification of Diet in Renal Disease (MDRD) Study equations have not been validated in Asian Americans with varying degrees of glucose tolerance. We compared both equations to 24-h urinary creatinine clearance, the latter as a standard measurement of glomerular filtration rate (GFR), in 398 Japanese Americans (62.1+/-5.8 years, mean+/-S.D.) who had normal glucose tolerance (NGT) (n=138), impaired glucose tolerance (IGT) (n=136) and diabetes (n=124). Although both the Cockcroft-Gault (r=0.65, P<0.001) and the MDRD (r=0.74, P<0.001) equations correlated well with creatinine clearance, the latter was significantly superior (P=0.013 between r values). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the MDRD equation was significantly greater than for the Cockcroft-Gault equation (AUC 0.86 versus 0.80, P=0.015) in classifying subjects as having mildly reduced GFR (<90ml/min per 1.73m(2)). However, both equations overestimated the number of individuals with decreased GFR. We conclude therefore that while the MDRD equation more accurately identifies Asians who are in the early stages of kidney disease, as for other groups, a correction term appears necessary in order to reduce the number of Asian subjects being falsely diagnosed with CKD.
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System, University of Washington, Seattle, WA 98108, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gerchman
authors.forename: Jenny
authors.initials: J
authors.lastname: Tong
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Utzschneider
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hull
authors.forename: Sakeneh
authors.initials: S
authors.lastname: Zraika
authors.forename: Jayalakshmi
authors.initials: J
authors.lastname: Udayasankar
authors.forename: Marguerite J
authors.initials: MJ
authors.lastname: McNeely
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Andress
authors.forename: Donna L
authors.initials: DL
authors.lastname: Leonetti
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Wilfred Y
authors.initials: WY
authors.lastname: Fujimoto
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
mesh_terms: D000368:Aged; D044466:Asian People; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood / Q000652:urine; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D018149:Glucose Intolerance / Q000503:physiopathology; D005951:Glucose Tolerance Test; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000175:diagnosis / Q000178:diet therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D003404:Creatinine