title: Validation of the Lund-Malmö, Chronic Kidney Disease Epidemiology (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations to estimate glomerular filtration rate in a large Swedish clinical population.
abstract: OBJECTIVE
  The aim of this study was to validate externally the Swedish Lund-Malmö revised creatinine-based glomerular filtration rate (GFR) equations (LM Revised) in a Swedish cohort in comparison with the North American Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations.
  
  
  METHODS
  The study included 1397 examinations [median age 61 years, median body mass index (BMI) 26 kg/m(2)] in 996 patients referred for iohexol clearance (median 44 ml/min/1.73 m(2)). Bias, precision [interquartile range (IQR)], accuracy expressed as percentage of estimates ± 10% (P(10)) and ± 30% (P(30)) of measured GFR, and classification ability for five GFR stages (<15, 15-29, 30-59, 60-89 and ≥90 ml/min/1.73 m(2)) were compared.
  
  
  RESULTS
  Overall, all three equations performed satisfactorily: LM Revised, MDRD, CKD-EPI showed, respectively, a median bias of -5.8%, -2.2% and 1.7%, IQR 11.9, 12.3 and 11.7 ml/min/1.73 m(2), P(10) 35%, 34% and 38%, P(30) 84%, 79% and 79% and correctly classified GFR stages 68%, 65% and 69%. LM Revised was at least as accurate in terms of P(30) as the other equations at GFR intervals <90, while CKD-EPI was the only unbiased and the most accurate equation at ≥90 ml/min/1.73 m(2). LM Revised was more stable in terms of bias and accuracy across age and BMI groups than MDRD and CKD-EPI. Both MDRD and CKD-EPI overestimated measured GFR among elderly patients and in the small group of underweight men.
  
  
  CONCLUSIONS
  The ideal all-purpose GFR prediction equation does not exist. LM Revised should be preferred in patients with suspected or known renal insufficiency, while CKD-EPI is most useful in settings where patients with no a priori suspicion of renal impairment are evaluated. Differences in creatinine measurements between laboratories may limit the generalizability of the present validation.
authors.affiliation: Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Björk
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
authors.forename: Ulf
authors.initials: U
authors.lastname: Nyman
authors.forename: Per
authors.initials: P
authors.lastname: Sjöström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers; D015992:Body Mass Index; D015331:Cohort Studies; D003287:Contrast Media / Q000378:metabolism; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis*; D013548:Sweden
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D007472:Iohexol; D003404:Creatinine