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, Daijo Inaguma, Ichiei Narita, Hiroyasu Iso, Kenji Wakai, Yoshinari Yasuda, Yusuke Tsukamoto, Sadayoshi Ito, Hirofumi MakinoAkira Hishida, Seiichi Matsuo

Research output: Contribution to journalArticle

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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 x MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 x 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 x MDRD equation than that with the 1.0 x 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 x MDRD equation than with the 1.0 x MDRD study equation. In Cin less than 60 ml/min per 1.73 m 2, 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.

Original languageEnglish
Pages (from-to)41-50
Number of pages10
JournalClinical and Experimental Nephrology
Volume11
Issue number1
DOIs
Publication statusPublished - 01-03-2007

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Diet Therapy
Glomerular Filtration Rate
Chronic Renal Insufficiency
Kidney
Creatinine
Inulin
Serum

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Imai, Enyu ; Horio, Masaru ; Nitta, Kosaku ; Yamagata, Kunihiro ; Iseki, Kunitoshi ; Hara, Shigeko ; Ura, Nobuyuki ; Kiyohara, Yutaka ; Hirakata, Hideki ; Watanabe, Tsuyoshi ; Moriyama, Toshiki ; Ando, Yasuhiro ; Inaguma, Daijo ; Narita, Ichiei ; Iso, Hiroyasu ; Wakai, Kenji ; Yasuda, Yoshinari ; Tsukamoto, Yusuke ; Ito, Sadayoshi ; Makino, Hirofumi ; Hishida, Akira ; Matsuo, Seiichi. / Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. In: Clinical and Experimental Nephrology. 2007 ; Vol. 11, No. 1. pp. 41-50.
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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 Jaff{\'e} 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 Jaff{\'e} 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 x MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 x 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 x MDRD equation than that with the 1.0 x 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 x MDRD equation than with the 1.0 x MDRD study equation. In Cin less than 60 ml/min per 1.73 m 2, 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.",
author = "Enyu Imai and Masaru Horio and Kosaku Nitta and Kunihiro Yamagata and Kunitoshi Iseki and Shigeko Hara and Nobuyuki Ura and Yutaka Kiyohara and Hideki Hirakata and Tsuyoshi Watanabe and Toshiki Moriyama and Yasuhiro Ando and Daijo Inaguma and Ichiei Narita and Hiroyasu Iso and Kenji Wakai and Yoshinari Yasuda and Yusuke Tsukamoto and Sadayoshi Ito and Hirofumi Makino and Akira Hishida and Seiichi Matsuo",
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Imai, E, Horio, M, Nitta, K, Yamagata, K, Iseki, K, Hara, S, Ura, N, Kiyohara, Y, Hirakata, H, Watanabe, T, Moriyama, T, Ando, Y, Inaguma, D, Narita, I, Iso, H, Wakai, K, Yasuda, Y, Tsukamoto, Y, Ito, S, Makino, H, Hishida, A & Matsuo, S 2007, 'Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease', Clinical and Experimental Nephrology, vol. 11, no. 1, pp. 41-50. https://doi.org/10.1007/s10157-006-0453-4

Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. / Imai, Enyu; Horio, Masaru; Nitta, Kosaku; Yamagata, Kunihiro; Iseki, Kunitoshi; Hara, Shigeko; Ura, Nobuyuki; Kiyohara, Yutaka; Hirakata, Hideki; Watanabe, Tsuyoshi; Moriyama, Toshiki; Ando, Yasuhiro; Inaguma, Daijo; Narita, Ichiei; Iso, Hiroyasu; Wakai, Kenji; Yasuda, Yoshinari; Tsukamoto, Yusuke; Ito, Sadayoshi; Makino, Hirofumi; Hishida, Akira; Matsuo, Seiichi.

In: Clinical and Experimental Nephrology, Vol. 11, No. 1, 01.03.2007, p. 41-50.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease

AU - Imai, Enyu

AU - Horio, Masaru

AU - Nitta, Kosaku

AU - Yamagata, Kunihiro

AU - Iseki, Kunitoshi

AU - Hara, Shigeko

AU - Ura, Nobuyuki

AU - Kiyohara, Yutaka

AU - Hirakata, Hideki

AU - Watanabe, Tsuyoshi

AU - Moriyama, Toshiki

AU - Ando, Yasuhiro

AU - Inaguma, Daijo

AU - Narita, Ichiei

AU - Iso, Hiroyasu

AU - Wakai, Kenji

AU - Yasuda, Yoshinari

AU - Tsukamoto, Yusuke

AU - Ito, Sadayoshi

AU - Makino, Hirofumi

AU - Hishida, Akira

AU - Matsuo, Seiichi

PY - 2007/3/1

Y1 - 2007/3/1

N2 - 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 x MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 x 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 x MDRD equation than that with the 1.0 x 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 x MDRD equation than with the 1.0 x MDRD study equation. In Cin less than 60 ml/min per 1.73 m 2, 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.

AB - 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 x MDRD or CG equations. The MDRD study equation modified with the Japanese coefficient (0.881 x 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 x MDRD equation than that with the 1.0 x 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 x MDRD equation than with the 1.0 x MDRD study equation. In Cin less than 60 ml/min per 1.73 m 2, 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.

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