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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Estimating Kidney Function in Healthy People
21 December 2004 | Volume 141 Issue 12 | Page I-40
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Using Serum Creatinine To Estimate Glomerular Filtration Rate: Accuracy in Good Health and in Chronic Kidney Disease." It is in the 21 December 2004 issue of Annals of Internal Medicine (volume 141, pages 929-937). The authors are A. Rule, T.S. Larson, E.J. Bergstralh, J.M. Slezak, S.J. Jacobsen, and F.G. Cosio.
What is the problem and what is known about it so far?
The most accurate way to assess kidney function is to measure a person's glomerular filtration rate (GFR). The GFR shows how well the kidneys filter waste from the blood. Measuring GFR requires injecting a substance into the bloodstream and seeing how well it is cleared from the body with a 24-hour urine collection. Another option is to estimate GFR by using formulas that include a patient's age, sex, and creatinine value (a simple blood test that measures waste products). One of these formulas is called the Modification of Diet in Renal Disease (MDRD) equation. The ability of this equation to estimate GFR has been tested in patients with kidney disorders, but we do not know how well it performs in relatively healthy people without known kidney disease.
Why did the researchers do this particular study?
The researchers wanted to see if the MDRD equation estimates GFR equally well in patients with and without known kidney disease. They also wanted to find a new equation that would estimate GFR better than the MDRD equation.
Who was studied?
320 patients age 17 to 87 years with chronic kidney disease and 580 healthy kidney donor candidates age 18 to 72 years.
How was the study done?
The researchers reviewed medical records of adults who were seen at the Mayo Clinic in Rochester, Minnesota, from 1996 to 2003 either for chronic kidney disease or as potential kidney donors. They found people who had had blood tests for creatinine and GFR measurements (iothalamate clearance tests). They calculated the MDRD equation estimate of GFR based on each person's age, sex, and creatinine value. They then compared the MDRD equation estimate with the actual GFR measurement in both groups of patients. Finally, they formulated a higher-order equation (a quadratic equation) that combined the age, sex, and creatinine values in a different manner and tested its ability to estimate GFR.
What did the researchers find?
The MDRD equation underestimated kidney function by small amounts (6%) in the patients with kidney disease and by large amounts (29%) in the healthy adults. Among the healthy adults, the higher-order equation better estimated renal function than did the MDRD equation.
What were the limitations of the study?
The study included only 7 African Americans and few people older than 65 years of age. The proposed new equation might not work well in these patients. It should not be used routinely until it has been tested in larger and more diverse populations.
What are the implications of the study?
The MDRD equation underestimates kidney function. Using it may mistakenly label some healthy individuals as having kidney disease.
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J. H. Ix, M. G. Shlipak, G. M. Chertow, and M. A. Whooley Association of Cystatin C With Mortality, Cardiovascular Events, and Incident Heart Failure Among Persons With Coronary Heart Disease: Data From the Heart and Soul Study Circulation, January 16, 2007; 115(2): 173 - 179. [Abstract] [Full Text] [PDF]
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L. F. Fried, M. L. Biggs, M. G. Shlipak, S. Seliger, B. Kestenbaum, C. Stehman-Breen, M. Sarnak, D. Siscovick, T. Harris, J. Cauley, et al. Association of Kidney Function with Incident Hip Fracture in Older Adults J. Am. Soc. Nephrol., January 1, 2007; 18(1): 282 - 286. [Abstract] [Full Text] [PDF]
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J. Iglesias, D. Hom, M. Antoniotti, S. Ayoub, and J. S. Levine Predictors of worsening renal function in adult patients with congestive heart failure receiving recombinant human B-type brain natriuretic peptide (nesiritide) Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3458 - 3465. [Abstract] [Full Text] [PDF]
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G. Placha, G. D. Poznik, J. Dunn, A. Smiles, B. Krolewski, T. Glew, S. Puppala, J. Schneider, J. J. Rogus, S. S. Rich, et al. A Genome-Wide Linkage Scan for Genes Controlling Variation in Renal Function Estimated by Serum Cystatin C Levels in Extended Families With Type 2 Diabetes Diabetes, December 1, 2006; 55(12): 3358 - 3365. [Abstract] [Full Text] [PDF]
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P. M. Rainey Automatic Reporting of Estimated Glomerular Filtration Rate--Jumping the Gun? Clin. Chem., December 1, 2006; 52(12): 2184 - 2187. [Full Text] [PDF]
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A. S. Levey, L. A. Stevens, and T. Hostetter Automatic Reporting of Estimated Glomerular Filtration Rate--Just What the Doctor Ordered Clin. Chem., December 1, 2006; 52(12): 2188 - 2193. [Full Text] [PDF]
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J. Redon, F. Morales-Olivas, A. Galgo, M. A. Brito, J. Mediavilla, R. Marin, P. Rodriguez, S. Tranche, J. V. Lozano, C. Filozof, et al. Urinary Albumin Excretion and Glomerular Filtration Rate across the Spectrum of Glucose Abnormalities in Essential Hypertension J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S236 - S245. [Abstract] [Full Text] [PDF]
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A. S. Go, W. Y. Lee, J. Yang, J. C. Lo, and J. H. Gurwitz Statin therapy and risks for death and hospitalization in chronic heart failure. JAMA, November 1, 2006; 296(17): 2105 - 2111. [Abstract] [Full Text] [PDF]
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C. J. Diskin Creatinine and GFR: an imperfect marriage of convenience Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3338 - 3339. [Full Text] [PDF]
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P.J. Twomey and T.M. Reynolds The MDRD formula and validation QJM, November 1, 2006; 99(11): 804 - 805. [Full Text] [PDF]
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B. Kiberd The Chronic Kidney Disease Epidemic: Stepping Back and Looking Forward J. Am. Soc. Nephrol., November 1, 2006; 17(11): 2967 - 2973. [Abstract] [Full Text] [PDF]
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G. L. Schwartz and S. C. Textor Early Referral for Chronic Kidney Disease: Good for Those Who Need It, but Who Are They? Mayo Clin. Proc., November 1, 2006; 81(11): 1420 - 1422. [Full Text] [PDF]
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A. D. Rule, R. J. Rodeheffer, T. S. Larson, J. C. Burnett Jr, F. G. Cosio, S. T. Turner, and S. J. Jacobsen Limitations of Estimating Glomerular Filtration Rate From Serum Creatinine in the General Population Mayo Clin. Proc., November 1, 2006; 81(11): 1427 - 1434. [Abstract] [Full Text] [PDF]
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