Journal of Public Health

, Volume 25, Issue 4, pp 401–407 | Cite as

Diagnostic accuracy of different methods of early detection of chronic kidney disease

  • Luciana Saraiva da SilvaEmail author
  • Rosângela Minardi Mitre Cotta
  • Tiago Ricardo Moreira
  • Rodrigo Gomes da Silva
Original Article



To assess the accuracy of the CG, CG-corrected, MDRD-6, MDRD-4 and CKD-EPI formulae when diagnosing CKD and to compare the results for creatinine clearance.

Subject and methods

This cross-sectional study was conducted with hypertensive individuals monitored by the Primary Health Care Service in Brazil (n = 293). Renal function was analyzed based on serum creatinine levels and creatinine clearance (24 h). The GFR was estimated using the CG, CG-corrected, MDRD-6, MDRD-4 and CKD-EPI formulae. The accuracy of the CKD diagnosis was assessed by analyzing sensitivity and specificity with confidence intervals (95%), receiver-operator characteristic (ROC) curve and the area under the curve (AUC) values.


The CKD-EPI formula provided the best balance between sensitivity, 76.7 (66.4–85.2), and specificity, 71.9 (65.3–78.0), as well as the highest AUC value (0.808). Concerning the ROC analysis, the curve of the CKD-EPI formula confirmed its greater precision.


The results of the present study indicate that the CKD-EPI formula is the best method for estimating the GFR. Thus, it is possible to implement low-cost actions focused on the early detection and prevention of complications of CKD.


Chronic kidney disease Disease prevention Early diagnosis Kidney function tests 


Compliance with ethical standards


This study received support from the Foundation for Research Support in the State of Minas Gerais, Brazil (FAPEMIG-process no. CDS-APQ-03594-12) and the Coordination for the Improvement of Higher Education (CAPES), an entity of the Brazilian Government that coordinates human resources (AUX-PE-PRO-HEALTH EDUCATION 2034/2010–process no. 23038.009788/2010-78).

Disclosure of potential conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The present study was approved by the Human Research Ethics Committee of the Universidade Federal de Viçosa (UFV) under protocol no. 044/2012.

Informed consent

Informed consent was obtained from all individual participants included in the study. As per Resolution 466/2012 of the National Health Council, which regulates research involving human subjects, the participants signed a free and informed statement of consent, which ensured the confidentiality of the data and the anonymity of the participants.


  1. Bastos M, Bastos R, Paula R (2007) Avaliação da função renal. In: Barros E, Gonçalves L (eds) Nefrologia no consultório. Artmed, Porto Alegre, pp 49–67Google Scholar
  2. Bastos MG, Kirsztajn GM (2011) Chronic kidney disease: importance of early diagnosis, immediate referral and structured interdisciplinary approach to improve outcomes in patients not yet on dialysis. J Bras Nefrol 33:74–87CrossRefGoogle Scholar
  3. Brown WW, Peters RM, Ohmit SE, Keane WF, Collins A, Chen SC, King K, Klag MJ, Molony DA, Flack JM (2003) Early detection of kidney disease in community settings: the kidney early evaluation program (KEEP). Am J Kidney Dis 42:22–35CrossRefGoogle Scholar
  4. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41CrossRefGoogle Scholar
  5. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047. doi: 10.1001/jama.298.17.2038 CrossRefPubMedGoogle Scholar
  6. Hamer RA, El Nahas AM (2006) The burden of chronic kidney disease. BMJ 332:563–564. doi: 10.1136/bmj.332.7541.563 CrossRefPubMedPubMedCentralGoogle Scholar
  7. Jelliffe D (1968) Evaluación del estado de nutrición de la comunidad Ginebra: OMS :260–261Google Scholar
  8. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY, Yang CW (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382:260–272CrossRefGoogle Scholar
  9. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and Management of Chronic Kidney Disease. Kidney Int 3:1–150CrossRefGoogle Scholar
  10. Kirsztajn GM, Souza E, Romão Jr JE, Bastos MG, Meyer F, Andrada N (2011) Doença Renal Crônica (Pré-terapia Renal Substitutiva): DiagnósticoGoogle Scholar
  11. Lamb EJ, Stevens PE (2014) Estimating and measuring glomerular filtration rate: methods of measurement and markers for estimation. Curr Opin Nephrol Hypertens 23:258–266CrossRefGoogle Scholar
  12. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470CrossRefGoogle Scholar
  13. Levey A, Bosch J, Lewis J, Shahriari AR, Rogers N, Roth D (2000) A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 11:155AGoogle Scholar
  14. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F, Chronic Kidney Disease Epidemiology Collaboration (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254CrossRefGoogle Scholar
  15. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Chronic Kidney Disease Epidemiology Collaboration (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612CrossRefGoogle Scholar
  16. Lipschitz DA (1994) Screening for nutritional status in the elderly. Primary care 21:55–67PubMedGoogle Scholar
  17. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, … Murray CJL (2013) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010 Lancet 380:2095–2128Google Scholar
  18. Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, Xu JS, Huang SM, Wang LN, Huang W, Wang M, Xu GB, Wang HY (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944CrossRefGoogle Scholar
  19. Matsudo S, Araújo T, Marsudo V, Andrade D, Andrade E, Braggion G (2001) Questinário internacional de atividade f1sica (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde 6:05–18Google Scholar
  20. Motta VT, Oliveira Filho, PFd (2009) SPSS: Análise de dados biomédicos. In: SPSS: análise de dados biomédicos. MedbookGoogle Scholar
  21. Rossing P, Rossing K, Gæde P, Pedersen O, Parving H-H (2006) Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. Diabetes Care 29:1024–1030CrossRefGoogle Scholar
  22. Rule AD, Gussak HM, Pond GR, Bergstralh EJ, Stegall MD, Cosio FG, Larson TS (2004) Measured and estimated GFR in healthy potential kidney donors. Am J Kidney Dis 43:112–119CrossRefGoogle Scholar
  23. Shemesh O, Golbetz H, Kriss JP, Myers BD (1985) Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 28:830–838CrossRefGoogle Scholar
  24. Silva ABT, Molina MCB, Rodrigues SL, Pimentel EB, Baldo MP, Mill JG (2010) Correlação entre a depuração plasmática de creatinina utilizando urina coletada durante 24 horas e 12 horas. J Bras Nefrol 32:165–172CrossRefGoogle Scholar
  25. Sistema de Hipertensão e Diabetes (SisHiperDia) (2012) Ministério da Saúde. DATASUS. Número de Diabéticos, Hipertensos e Diabéticos com Hipertensão por sexo, tipo e risco. Accessed 12 April 2012
  26. Sociedade Brasileira de Nefrologia (2013) Censo da Sociedade Brasileira de Nefrologia. Accessed 07 July 2014
  27. Sodré FL, Costa JCB, Lima JCC (2007) Avaliação da função e da lesão renal: um desafio laboratorial:[revisão]. J Bras Patol Med Lab 43:329–337CrossRefGoogle Scholar
  28. USRDS (2015) United States renal data system. 2015 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, BethesdaGoogle Scholar
  29. World Health Organization (2000) Obesity: preventing and managing the global epidemics (Series 894) World Health OrganizationGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Luciana Saraiva da Silva
    • 1
    Email author
  • Rosângela Minardi Mitre Cotta
    • 1
  • Tiago Ricardo Moreira
    • 2
  • Rodrigo Gomes da Silva
    • 3
  1. 1.Department of Nutrition and HealthFederal University of ViçosaViçosaBrazil
  2. 2.Department of Nursing and MedicineFederal University of ViçosaViçosaBrazil
  3. 3.Department of NephrologySão João Batista HospitalViçosaBrazil

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