A New Equation to Estimate Glomerular Filtration Rate

作者：Levey Andrew S^*; Stevens Lesley A; Schmid Christopher H; Zhang Yaping; Castro Alejandro F III; Feldman Harold I; Kusek John W; Eggers Paul; Van Lente Frederick; Greene Tom; Coresh Josef

来源：Annals of Internal Medicine, 2009, 150(9): 604-612.

DOI：10.7326/0003-4819-150-9-200905050-00006

Background: Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values.
Objective: To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Design: Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U. S. population for prevalence estimates.
Setting: Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006.
Participants: 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16 032 participants in NHANES.
Measurements: GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age.
Results: In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) ( IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%).
Limitation: The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR.
Conclusion: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases.

• 出版日期2009-5-5