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


METHODS
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.
Xie
Dawei
D
Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA 19104, USA.
Joffe
Marshall M
MM
Brunelli
Steven M
SM
Beck
Gerald
G
Chertow
Glenn M
GM
Fink
Jeffrey C
JC
Greene
Tom
T
Hsu
Chi-yuan
CY
Kusek
John W
JW
Landis
Richard
R
Lash
James
J
Levey
Andrew S
AS
O'Conner
Andrew
A
Ojo
Akinlolu
A
Rahman
Mahboob
M
Townsend
Raymond R
RR
Wang
Hao
H
Feldman
Harold I
HI
D000328:Adult; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007483:Iothalamic Acid; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D007483:Iothalamic Acid