Nephrol Dial Transplant (2002) 17: 7-9
© 2002 European Renal Association-European Dialysis and Transplant Association
SECTION I: Measurement of renal function, when to refer and when to start dialysis
I.1 Measurement of renal function
AbstractGuideline I.1.1
A. Renal function should not be estimated from measurements of blood urea or creatinine alone. Cockcroft and Gault equation or reciprocal creatinine plots should not be used when the glomerular filtration rate (GFR) is <30 ml/min or to determine the need for dialysis.
(Evidence level: A)
Guideline I.1.2
A. To reduce confusion when communicating with general physicians and to encourage timely referral of patients with renal failure:
Renal function should be reported as GFR equivalent (ml/min/1.73 m2).
(Evidence level: C)
Dialysis terms such as Kt/V and weekly creatinine clearance should be avoided.
(Evidence level: C)
Guideline I.1.3
A. GFR should only be estimated using a method, which has been validated in patients with advanced renal failure. The preferred method for calculating GFR in advanced renal failure is the mean of urea and creatinine clearance. The latter is best calculated from a 24-h urine collection and normalized to 1.73 m2.
(Evidence level: C)
B. Other examples of validated GFR estimations are:
- MDRD equation
- Indicator decay methods (e.g. iohexol, iothalamate, EDTA, inulin)
- Creatinine clearance after oral cimetidine
Guideline I.1.4
A. To assist in the standard reporting of renal function in advanced renal failure, the preferred methods of estimating GFR in advanced renal failure are EITHER:
MDRD equation
(Evidence level: B) (Appendix I)
OR
The mean of urea and creatinine clearance, calculated from 24-h urine collections and normalized to 1.73 m2; preferably using the Gehan and George method for calculating surface area.
(Evidence level: B) (Appendix I)
Guideline I.1.5
A. To assist in the detection and timely referral of patients with renal failure, laboratories should be encouraged to report the GFR using the MDRD equation when serum creatinine above the normal range is measured and there is insufficient data to calculate GFR more directly.
(Evidence level: C)
B. If creatinine clearance is requested from a 24-h urine collection, the laboratories should also report GFR calculated from the mean of urea and creatinine clearance. The report should indicate that this GFR is not normalized for surface area and should show indicative normal ranges for different sized patients.
(Evidence level: C)