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NDT Advance Access published online on August 12, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp391
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Comparison between creatinine-based equations for estimating total creatinine clearance in peritoneal dialysis: a multicentre study

Giovambattista Virga1, Vincenzo La Milia2, Roberto Russo3, Luciana Bonfante4, Marilena Cara1 and Maurizio Nordio1

1 Nephrology and Dialysis Unit, Provincial Hospital, Camposampiero (Padova) 2 Department of Nephrology and Dialysis, Ospedale ‘A. Manzoni’, Lecco 3 Renal, Dialysis and Transplant Unit, University of Bari, Policlinico, Bari 4 Division of Nephrology, Department of Medical and Surgical Sciences, University Hospital of Padova, Italy

Correspondence and offprint requests to: Giovambattista Virga; E-mail: virgolino14{at}libero.it



  Abstract

Background. It is crucial to assess the adequacy of peritoneal dialysis (PD) because of its influence on patient outcome. Collecting dialysate and urine for 24 h can be rather troublesome, so a simple and inexpensive alternative method for rapidly evaluating adequacy in PD would be very useful. Our study aimed to assess the performance of 12 different creatinine (Cr)-based equations commonly used to estimate GFR in predicting total Cr clearance (totCrCL) in PD.

Methods. Four Italian dialysis centres enrolled 355 PD patients with 2916 fluid collections. To rank the equations, their accuracy (median absolute percentage error, MAPE), precision (root mean square error, RMSE), agreement (k statistics), sensitivity and specificity (area under ROC curves, AUC, where x = 1 – specificity and y = sensitivity) were calculated with reference to the measured totCrCL.

Results. The Gates, Virga and 4-MDRD equations showed the best global performance as concerns accuracy (MAPE = 14.1, 16.3, 15.9% respectively), precision (RMSE = 13.2, 13.3, 13.4), agreement (k = 0.425, 0.440, 0.375), sensitivity and specificity (AUC = 0.825, 0.826, 0.820), while the Cockcroft–Gault formula revealed a rather poor reliability.

Conclusions. Fluid collection remains the gold standard for assessing PD adequacy. Our study ascertained how 12 Cr-based equations performed in estimating totCrCL in PD patients with a view to enabling the most accurate and precise among them to be chosen for use in approximately assessing totCrCL.

Keywords: accuracy; adequacy; creatinine clearance; creatinine-based equations; peritoneal dialysis

Received for publication: 21. 1.09
Accepted in revised form: 13. 7.09


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