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Other Areas of Clinical Chemistry |
1 Division of Nephrology, Tufts-New England Medical Center, Boston, MA.
2 Johns Hopkins Medical Institutions, Baltimore, MD.
3 Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH.
4 National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD.
5 Department of Clinical Pathology, Cleveland Clinic Foundation, Cleveland, OH.
aAddress correspondence to this author at: Division of Nephrology, Tufts-New England Medical Center, 750 Washington St., Box 391, Boston, MA 02111. Fax 617-636-8329; e-mail lstevens1{at}tufts-nemc.org.
Purpose: We sought to reexpress the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation for estimation of glomerular filtration rate (GFR) using serum creatinine (Scr) standardized to reference methods.
Methods: Serum specimens included creatinine reference materials prepared by the College of American Pathologists (CAP), traceable to primary reference material at the NIST, with assigned values traceable to isotope dilution mass spectrometry (IDMS), a calibration panel prepared by the Cleveland Clinic Research Laboratory (CCRL), and frozen samples from the MDRD Study. Split specimens were measured at the CCRL using the Roche enzymatic and Beckman CX3 kinetic alkaline picrate assays.
Results: Roche enzymatic assay results on CAP samples were comparable to IDMS-assigned values. Beckman CX3 assay results in 2004–2005 were significantly higher than but highly correlated with simultaneous Roche enzymatic assay results (r2 = 0.9994 on 40 CCRL samples) and showed minimal but significant upward drift from Beckman CX3 assay results during the MDRD Study in 1989–1991 (r2 = 0.9987 in 253 samples). Combining these factors, standardized Scr = 0.95 x original MDRD Study Scr. The reexpressed 4-variable MDRD Study equation for Scr (mg/dL) is GFR = 175 x standardized Scr–1.154 x age–0.203 x 1.212 (if black) x 0.742 (if female), and for Scr (µmol/L) is GFR = 30849x standardized Scr–1.154 x age–0.203 x 1.212 (if black) x 0.742 (if female) [GFR in mL · min–1 · (1.73 m2)–1].
Conclusion: When the calibration of Scr methods is traceable to the Scr reference system, GFR should be estimated using the MDRD Study equation that has been reexpressed for standardized Scr.
The following articles in journals at HighWire Press have cited this article:
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A. Stavroulopoulos, O. Sahota, I. Qamar, C. J. Porter, M. J.D. Cassidy, and S. D. Roe Presence of chronic kidney disease stages 3 and 4 in patients with low trauma fracture Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2710 - 2711. [Full Text] [PDF]
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J. R. Delanghe How to estimate GFR in children Nephrol. Dial. Transplant., May 29, 2008; (2008) gfn306v1. [Full Text] [PDF]
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J. Coresh, L. A. Stevens, and A. S. Levey Chronic kidney disease is common: What do we do next? Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1122 - 1125. [Full Text] [PDF]
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 B. G. Jaar, R. Khatib, L. Plantinga, L. E. Boulware, and N. R. Powe Principles of Screening for Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 601 - 609. [Full Text] [PDF]
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F. Ceriotti, J. C. Boyd, G. Klein, J. Henny, J. Queralto, V. Kairisto, M. Panteghini, and on behalf of the IFCC Committee on Reference Inter Reference Intervals for Serum Creatinine Concentrations: Assessment of Available Data for Global Application Clin. Chem., March 1, 2008; 54(3): 559 - 566. [Abstract] [Full Text] [PDF]
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 P. Delanaye, E. Cavalier, and J. M. Krzesinski Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate JAMA, February 13, 2008; 299(6): 631 - 631. [Full Text] [PDF]
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J. Coresh, L. A. Stevens, and A. S. Levey Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate--Reply JAMA, February 13, 2008; 299(6): 631 - 632. [Full Text] [PDF]
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M. P. Quinn, A. Rainey, K. J. Cairns, A. H. Marshall, G. Savage, F. Kee, A. Peter Maxwell, E. Reaney, and D. G. Fogarty The practical implications of using standardized estimation equations in calculating the prevalence of chronic kidney disease Nephrol. Dial. Transplant., February 1, 2008; 23(2): 542 - 548. [Abstract] [Full Text] [PDF]
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 P.D. Giles, P.B. Rylance, and D.C. Crothers New results from the Modification of Diet in Renal Disease study: the importance of clinical outcomes in test strategies for early chronic kidney disease QJM, February 1, 2008; 101(2): 155 - 158. [Abstract] [Full Text] [PDF]
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D. M. Parry Use of Single-Value Protein Compensation of the Jaffe Creatinine Assay Contributes to Clinically Significant Inaccuracy in Results Clin. Chem., January 1, 2008; 54(1): 215 - 216. [Full Text] [PDF]
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J. Coresh, E. Selvin, L. A. Stevens, J. Manzi, J. W. Kusek, P. Eggers, F. Van Lente, and A. S. Levey Prevalence of Chronic Kidney Disease in the United States JAMA, November 7, 2007; 298(17): 2038 - 2047. [Abstract] [Full Text] [PDF]
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F. Artunc and T. Risler Serum erythropoietin concentrations and responses to anaemia in patients with or without chronic kidney disease Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2900 - 2908. [Abstract] [Full Text] [PDF]
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 L. A. Stevens, J. Coresh, H. I. Feldman, T. Greene, J. P. Lash, R. G. Nelson, M. Rahman, A. E. Deysher, Y. Zhang, C. H. Schmid, et al. Evaluation of the Modification of Diet in Renal Disease Study Equation in a Large Diverse Population J. Am. Soc. Nephrol., October 1, 2007; 18(10): 2749 - 2757. [Abstract] [Full Text] [PDF]
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