NDT Advance Access published online on September 30, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp510
Development and validation of GFR-estimating equations using diabetes, transplant and weight
1 Tufts Medical Center, Boston, MA 2 Johns Hopkins University, Baltimore, MD 3 University of Pennsylvania School of Medicine, Philadelphia, PA, USA 4 Lund University Hospital, Lund, Sweden 5 University of Miami Miller School of Medicine, Miami, FL 6 Case Western Reserve University, Cleveland, OH 7 Baylor University Medical Center, Dallas, TX 8 Cleveland Clinic Foundation, Cleveland, OH, USA 9 Steno Diabetes Center, Gentofte, Denmark 10 Mayo Clinic, Rochester, MN 11 University of Maryland Medical Center, MD 12 National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD 13 University of Utah, Salt Lake City, UT, USA
Correspondence and offprint requests to: Lesley A. Stevens; E-mail: lstevens1{at}tuftsmedicalcenter.org
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Abstract |
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Background. We have reported a new equation (CKD-EPI equation) that reduces bias and improves accuracy for GFR estimation compared to the MDRD study equation while using the same four basic predictor variables: creatinine, age, sex and race. Here, we describe the development and validation of this equation as well as other equations that incorporate diabetes, transplant and weight as additional predictor variables.
Methods. Linear regression was used to relate log-measured GFR (mGFR) to sex, race, diabetes, transplant, weight, various transformations of creatinine and age with and without interactions. Equations were developed in a pooled database of 10 studies [2/3 (N = 5504) for development and 1/3 (N = 2750) for internal validation], and final model selection occurred in 16 additional studies [external validation (N = 3896)].
Results. The mean mGFR was 68, 67 and 68 ml/min/ 1.73 m2 in the development, internal validation and external validation datasets, respectively. In external validation, an equation that included a linear age term and spline terms in creatinine to account for a reduction in the magnitude of the slope at low serum creatinine values exhibited the best performance (bias = 2.5, RMSE = 0.250) among models using the four basic predictor variables. Addition of terms for diabetes and transplant did not improve performance. Equations with weight showed a small improvement in the subgroup with BMI <20 kg/m2.
Conclusions. The CKD-EPI equation, based on creatinine, age, sex and race, has been validated and is more accurate than the MDRD study equation. The addition of weight, diabetes and transplant does not significantly improve equation performance.
Keywords: creatinine; development; estimating equation; glomerular filtration rate; validation
Received for publication: 3. 3.09
Accepted in revised form: 1. 9.09