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Pregnancy Reduces the Accuracy of the Estimated Glomerular Filtration Rate Based on Cockroft-Gault and MDRD Formulas

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Abstract

Objective

This study aims to determine the effect of pregnancy on the accuracy of 3 commonly used methods to estimate glomerular filtration rate ([GFR] creatinine clearance, the Cockroft-Gault, and modification of diet in renal disease [MDRD] formulas) using the inulin clearance as a reference.

Design

Longitudinal study design. Setting: University hospital. Population: A total of 44 parous nonsmoking Caucasian women. They had a history of uneventful pregnancy (n = 9), preeclampsia (n = 27), and intrauterine fetal demise (n = 8).

Methods

Measurements were performed both in pre-pregnancy and early pregnancy (8 weeks of gestation) and included inulin infusion, blood pressure, and 24-hour urinary and serum creatinine. Agreement between methods to estimate GFR was assessed by the Bland and Altman method. Main outcome measures: GFR estimated by inulin and creatinine clearances and the Cockroft-Gault and MDRD formulas.

Results

During early pregnancy, the GFR measured by inulin increased 32% compared with the pre-pregnant value (from 115 ± 18 to 150 ± 23 mL/min·1.73 m−2), whilst the GFR measured by the indirect methods only increased 20%. The observed bias and limits of agreements are larger in early pregnancy relative to the pre-pregnant state for all 3 methods.

Conclusion

The renal hyperfiltration during pregnancy decreases further the accuracy of the creatinine clearance and the Cockroft-Gault and MDRD formulas to estimate GFR.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Maastricht University Medical Center, Peter Debyeplein 25, PO Box 5800, 6202 AZ, Maastricht, Netherlands

    Patricia M. J. L. Koetje MD, Julia J. Spaan MD & Louis L. Peeters MD, PhD

  2. Department of Nephrology, Maastricht University Medical Centre, Maastricht, Netherlands

    Jeroen P. Kooman MD, PhD

  3. Department of Obstetrics & Gynecology, Radboud Nijmegen University Medical Centre, Nijmegen, Netherlands, and the Research School GROW, Maastricht University Medical Centre, Maastricht, Netherlands

    Marc E. A. Spaanderman MD, PhD

Authors
  1. Patricia M. J. L. Koetje MD
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  2. Julia J. Spaan MD
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  3. Jeroen P. Kooman MD, PhD
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  4. Marc E. A. Spaanderman MD, PhD
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  5. Louis L. Peeters MD, PhD
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Correspondence to Louis L. Peeters MD, PhD.

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Koetje, P.M.J.L., Spaan, J.J., Kooman, J.P. et al. Pregnancy Reduces the Accuracy of the Estimated Glomerular Filtration Rate Based on Cockroft-Gault and MDRD Formulas. Reprod. Sci. 18, 456–462 (2011). https://doi.org/10.1177/1933719110387831

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