Advances in glomerular filtration rate-estimating equations.
OBJECTIVE
Estimated glomerular filtration rate (eGFR) is now commonly reported by clinical laboratories. Here, we review the performance of current creatinine and cystatin C-based estimating equations as well as demonstration of their utility in public health and clinical practice.


RESULTS
Lower levels of GFR are associated with multiple adverse outcomes, including acute kidney injury and medical errors. The new Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation improves performance and risk prediction compared with the Modification of Diet in Renal Disease study equation. Current cystatin C-based equations are not accurate in all populations, even in those with reduced muscle mass or chronic illness, in which cystatin C would be expected to outperform creatinine. eGFR reporting has led to a greater number of referrals to nephrologists, but the increased numbers do not appear to be excessive or burdensome. The Modification of Diet in Renal Disease study equation appears to be able to provide drug dosage adjustments similar to the Cockcroft-Gault equation.


CONCLUSIONS
Estimated GFRs and their reporting can improve and facilitate clinical practice for chronic kidney disease. Understanding strengths and limitations facilitates their optimal use. Endogenous filtration markers, alone or in combination, which are less dependent on non-GFR determinants of the filtration markers, are necessary to lead to more accurate eGFRs.
Stevens
Lesley A
LA
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts 02111, USA. LStevens1@tuftsmedicalcenter.org
Padala
Smita
S
Levey
Andrew S
AS
D055316:Cystatin C / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis*
D055316:Cystatin C
Med J Aust. 2005 Aug 1;183(3):138-41
16053416
Scand J Urol Nephrol. 2009;43(3):242-9
19291590
Ann Intern Med. 2004 Dec 21;141(12):929-37
15611490
Kidney Int. 2009 Aug;76(3):318-23
19436331
Kidney Int. 2009 Mar;75(6):652-60
19119287
Ann Pharmacother. 2006 Jul-Aug;40(7-8):1248-53
16835312
Clin J Am Soc Nephrol. 2008 Sep;3(5):1332-8
18667734
Am J Kidney Dis. 2010 Apr;55(4):660-70
20138414
Am J Kidney Dis. 2009 Jun;53(6):1050-8
19394733
Scand J Clin Lab Invest. 2005;65(2):153-62
16025838
J Nephrol. 2008 Nov-Dec;21(6):797-807
19034863
Nephrol Dial Transplant. 2008 Dec;23(12):3845-50
18632591
Diabetes Metab. 2008 Nov;34(5):482-9
18703370
J Am Soc Nephrol. 2009 Nov;20(11):2305-13
19833901
Nephrol Dial Transplant. 2007 Oct;22(10):2894-9
17575316
Kidney Int. 2004 Apr;65(4):1416-21
15086483
J Am Soc Nephrol. 2009 Oct;20(10):2214-22
19762497
Scand J Clin Lab Invest. 2004;64(1):25-30
15025426
Adv Clin Chem. 2000;35:63-99
11040958
Clin Nephrol. 2009 May;71(5):482-91
19473607
Curr Opin Nephrol Hypertens. 2006 May;15(3):276-84
16609295
Hypertension. 2003 Nov;42(5):1050-65
14604997
Kidney Int. 2005 Jun;67(6):2089-100
15882252
Am J Kidney Dis. 2009 Jul;54(1):33-42
19446939
Am J Kidney Dis. 2009 Jun;53(6):915-20
19406541
Clin Chem Lab Med. 2009;47(9):1017-9
19728841
Nephrology (Carlton). 2008 Dec;13(8):684-8
19154321
N Engl J Med. 2004 Sep 23;351(13):1296-305
15385656
Nephrol Dial Transplant. 2008 Mar;23(3):1072-3; author reply 1073
17984103
Clin Exp Nephrol. 2007 Mar;11(1):41-50
17384997
Nephrol Dial Transplant. 2009 Jan;24(1):109-16
18755849
J Am Coll Cardiol. 2003 Jan 1;41(1):47-55
12570944
Curr Opin Nephrol Hypertens. 2006 Nov;15(6):610-6
17053476
Clin Chem. 2005 Aug;51(8):1420-31
15961546
Am J Kidney Dis. 2010 Apr;55(4):648-59
20189275
Clin Chem. 2006 Jan;52(1):5-18
16332993
Kidney Int. 2009 Aug;76(3):245-7
19904255
Pharmacotherapy. 2008 Sep;28(9):1125-32
18752383
Nephrol Dial Transplant. 2008 Apr;23(4):1122-5
18359871
N Engl J Med. 2006 Jun 8;354(23):2473-83
16760447
J Am Coll Cardiol. 2008 Mar 11;51(10):991-6
18325437
Pharmacotherapy. 2009 Jun;29(6):649-55
19476418
Kidney Int. 2009 May;75(10):1009-14
19242501
Curr Opin Nephrol Hypertens. 2004 Jan;13(1):73-81
15090863
Clin J Am Soc Nephrol. 2009 May;4(5):965-72
19339409
Kidney Int. 2007 Aug;72(3):247-59
17568785
Clin J Am Soc Nephrol. 2009 Nov;4(11):1724-30
19808217
Ann Intern Med. 2009 May 5;150(9):604-12
19414839
Nephron. 1976;16(1):31-41
1244564
Am J Kidney Dis. 2009 Jul;54(1):1-3
19559334
Clin Biochem. 2009 Jan;42(1-2):108-10
18983837
Am J Kidney Dis. 2002 Aug;40(2):221-6
12148093
Am J Health Syst Pharm. 2009 Jan 15;66(2):154-61
19139480
Am J Kidney Dis. 2008 Mar;51(3):395-406
18295055
Clin Chim Acta. 2009 May;403(1-2):87-91
19361466
N Engl J Med. 2005 May 19;352(20):2122-4
15901867
Gynecol Oncol. 2006 Dec;103(3):1063-9
16875719
J Cyst Fibros. 2009 Jan;8(1):19-25
18799365
Nephrol Dial Transplant. 2008 Aug;23(8):2695-6; author reply 2696-9
18567889
Diabetes Care. 2008 Dec;31(12):2265-7
18835955
Clin Pharmacol Ther. 2009 Nov;86(5):465-7
19844220
Clin J Am Soc Nephrol. 2009 May;4(5):899-906
19406960
J Am Soc Nephrol. 2008 Dec;19(12):2414-9
18776123
Kidney Int. 2003 Mar;63(3):1121-9
12631096
Nephrol Dial Transplant. 2008 Feb;23(2):549-55
18065826
Am J Kidney Dis. 2009 Jun;53(6):932-5
19463761
Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
11904577
Am J Kidney Dis. 2009 Jun;53(6):982-92
19339088
Diabetologia. 2008 Sep;51(9):1714-8
18633593
Kidney Int. 2006 Jan;69(2):399-405
16408133
Nephrol Dial Transplant. 2008 Apr;23(4):1117-21
18359870
Kidney Int. 2008 Jul;74(1):101-7
18385668
Ann Pharmacother. 2008 Dec;42(12):1758-65
19047358