Clinical and Experimental Nephrology

, Volume 11, Issue 1, pp 41–50

Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease

  • Enyu Imai
  • Masaru Horio
  • Kosaku Nitta
  • Kunihiro Yamagata
  • Kunitoshi Iseki
  • Shigeko Hara
  • Nobuyuki Ura
  • Yutaka Kiyohara
  • Hideki Hirakata
  • Tsuyoshi Watanabe
  • Toshiki Moriyama
  • Yasuhiro Ando
  • Daiki Inaguma
  • Ichiei Narita
  • Hiroyasu Iso
  • Kenji Wakai
  • Yoshinari Yasuda
  • Yusuke Tsukamoto
  • Sadayoshi Ito
  • Hirofumi Makino
  • Akira Hishida
  • Seiichi Matsuo
ORIGINAL ARTICLE

Abstract

Background

Accurate estimation of the glomerular filtration rate (GFR) is crucial for the detection of chronic kidney disease (CKD). In clinical practice, GFR is estimated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) study equation or the Cockcroft-Gault (CG) equation instead of the time-consuming method of measured clearance for exogenous markers such as inulin. In the present study, the equations originally developed for a Caucasian population were tested in Japanese CKD patients, and modified with the Japanese coefficient determined by the data.

Methods

The abbreviated MDRD study and CG equations were tested in 248 Japanese CKD patients and compared with measured inulin clearance (Cin) and estimated GFR (eGFR). The Japanese coefficient was determined by minimizing the sum of squared errors between eGFR and Cin. Serum creatinine values of the enzyme method in the present study were calibrated to values of the noncompensated Jaffé method by adding 0.207 mg/dl, because the original MDRD study equation was determined by the data for serum creatinine values measured by the noncompensated Jaffé method. The abbreviated MDRD study equation modified with the Japanese coefficient was validated in another set of 269 CKD patients.

Results

There was a significant discrepancy between measured Cin and eGFR by the 1.0 × MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 × MDRD) determined for Japanese CKD patients yielded lower mean difference and higher accuracy for GFR estimation. In particular, in Cin 30–59 ml/min per 1.73 m2, the mean difference was significantly smaller with the 0.881 × MDRD equation than that with the 1.0 × MDRD study equation (1.9 vs 7.9 ml/min per 1.73 m2; P <?0.01), and the accuracy was significantly higher, with 60% vs 39% of the points deviating within 15%, and 97% vs 87% of points within 50%, respectively (both P <?0.01). Validation with the different data set showed the correlation between eGFR and Cin was better with the 0.881 × MDRD equation than with the 1.0 × MDRD study equation. In Cin less than 60 ml/min per 1.73 m2, the accuracy was significantly higher, with 85% vs 69% of the points deviating within 50% (P <?0.01), respectively. The mean difference was also significantly smaller (P <?0.01). However, GFR values calculated by the 0.881 × MDRD equation were still underestimated in the range of Cin over 60 ml/min per 1.73 m2.

Conclusions

Although the Japanese coefficient improves the accuracy of GFR estimation of the original MDRD study equation, a new equation is needed for more accurate estimation of GFR in Japanese patients with CKD stages 3 and 4.

Key words

Serum creatinine Inulin clearance Glomerular filtration rate Chronic kidney disease 

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Copyright information

© Japanese Society of Nephrology 2007

Authors and Affiliations

  • Enyu Imai
    • 1
  • Masaru Horio
    • 2
  • Kosaku Nitta
    • 3
  • Kunihiro Yamagata
    • 4
  • Kunitoshi Iseki
    • 5
  • Shigeko Hara
    • 6
  • Nobuyuki Ura
    • 7
  • Yutaka Kiyohara
    • 8
  • Hideki Hirakata
    • 9
  • Tsuyoshi Watanabe
    • 10
  • Toshiki Moriyama
    • 11
  • Yasuhiro Ando
    • 12
  • Daiki Inaguma
    • 13
  • Ichiei Narita
    • 14
  • Hiroyasu Iso
    • 15
  • Kenji Wakai
    • 16
  • Yoshinari Yasuda
    • 17
  • Yusuke Tsukamoto
    • 18
  • Sadayoshi Ito
    • 19
  • Hirofumi Makino
    • 20
  • Akira Hishida
    • 21
  • Seiichi Matsuo
    • 17
  1. 1.Department of NephrologyOsaka University Graduate School of MedicineOsakaJapan
  2. 2.Department of Functional Diagnostic ScienceOsaka University Graduate School of MedicineOsakaJapan
  3. 3.Fourth Department of MedicineTokyo Women's University of MedicineTokyoJapan
  4. 4.Department of Nephrology, Institute of Clinical Medicine, Graduate School of Comprehensive Human SciencesUniversity of TsukubaIbarakiJapan
  5. 5.Dialysis UnitUniversity Hospital of The RyukyusOkinawaJapan
  6. 6.Health Medical CenterToranomon HospitalTokyoJapan
  7. 7.Second Department of Internal MedicineSapporo Medical University School of MedicineHokkaidoJapan
  8. 8.Department of Environmental Medicine, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  9. 9.Nephrology and Dialysis CenterFukuoka Red Cross HospitalFukuokaJapan
  10. 10.Third Department of MedicineFukushima Medical UniversityFukushimaJapan
  11. 11.Healthcare CenterOsaka UniversityOsakaJapan
  12. 12.Department of NephrologyJichi Medical SchoolTochigiJapan
  13. 13.Tosei HospitalAichiJapan
  14. 14.Division of Nephrology and RheumatologyNiigata UniversityNiigataJapan
  15. 15.Department of Public HealthOsaka University Graduate School of MedicineOsakaJapan
  16. 16.Aichi Cancer InstituteAichiJapan
  17. 17.Department of NephrologyNagoya University Graduate School of MedicineAichiJapan
  18. 18.Syuwa General HospitalSaitamaJapan
  19. 19.Division of Nephrology, Endocrinology and Vascular MedicineTohoku University Graduate School of MedicineMiyagaiJapan
  20. 20.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  21. 21.First Department of MedicineHamamatsu University School of MedicineShizuokaJapan

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