engleski

Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in diabetic patients

The inadequacies and limitations of creatinine clearance as a marker to monitor kidney function are well described. We investigated GFR in diabetic patients with MDRD-IDMS and CKD-EPI equations. Creatinine measurements were made on Olympus AU600, by the spectrophotometric Jaffé method, traceable to IDMS method with CRM 967 and 909b. Depending on the eGFR, patients (n=954 ; age: 19 – 92 (median age 59) ; male: n=502 (52, 6%) ; both types of diabetes) were divided into 5 stages of chronic kidney disease (CKD) with the biggest difference in stage 1: MDRD (n=87 ; 9, 1%) and CKD-EPI (n=195 ; 20, 4%). Kappa index showed fair (0, 546), good (0, 643), very good (0, 852) and excellent agreement (0, 971) between MDRD and CKD-EPI for stages 1, 2, 3 and 4, respectively. Better agreement was observed when equations were compared in male patients (kappa indeks: stage 1 – 0, 668, stage 2 – 0, 728, stage 3 – 0, 899, stage 4 – 1, 000) and in patients older than 65, regardless of gender (kappa indeks: stage 2 – 0, 913, stage 3 – 0, 929, stage 4 – 0, 951) . Reference change value was 14, 0% both for MDRD and CKD-EPI eGFR. Individuality index was 0, 24 for MDRD and 0, 25 for CKD-EPI. CKD-EPI equation estimated higher GFR in diabetic patients and reclassified 108 MDRD-classified stage 2 patients (11, 3%) into stage 1 CKD. However, very good and excellent agreement was observed in more advanced stages of CKD. We conclude that both equations are suitable for longitudinal observation of kidney function in diabetic patients, but shouldn't be used interchangeably.

Kidney function ; GFR ; MDRD ; CKD-EPI ; formula

nije evidentirano