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Vol. 30. Issue. 3.May 2010
Pages 271-380
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Comment to Assessment of the new CKD-EPI equation...
Comentario a Valoración de la nueva ecuación CDK-EPI...
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José Escribano Serranoa, Teresa J Bautista Martínb, Alfredo L Michán Doñac
a UGC Poniente, La Línea de la Concepción, Jerez de la Frontera, Cadiz, España,
b UGC Laboratorio, La Línea de la Concepción, Jerez de la Frontera, Cadiz, España,
c Servicio Medicina Interna, Hospital SAS, Jerez de la Frontera, Cadiz, España,
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CKD grade classification by MDRD
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Dear Editor,  

 We read with great interest the prepublished article in your journal by Montañés et al.1 for two reasons. The first, due to its current nature; it has only been a few months since formulas to estimate glomerular filtration rate (eGFR) were published, based on CKD-EPI study (Chronic Kidney Disease Epidemiology Collaboration).2 The second reason is that our group is working, albeit more modestly, along the same lines.  

 In our project “Knowing Diabetes Numbers” we collected measurements of fasting plasma glucose and HbA1c (FPGHbA 1c) from September 2008 to February 2009 that were performed in the Department of Biochemistry of the Hospital of La Línea de la Concepción, where tests are carried out for the hospital and the six primary care centres (PC).  

 After excluding the 362 results that came from the outpatient nephrology clinic, 4,820 FPG-HbA1c results were collected (from patients with a mean age of 64 ± 14 years), 55% were made in women and 74% came from PC. Of these, creatinine was also requested in 3,461 (72%), the albumin/creatinine ratio was requested in 1,397 (29%), and a specific request for eGFR was made in only 80 (less than 2%). Subsequently, we calculated the eGFR in the 1,953 requests in which data were available for age, sex, and creatinine using the classical MDRD formula (coefficient 186),3 since the laboratory uses the modified kinetic Jaffé method (Beckman) without traceability to isotope dilution mass spectrometry (IDMS).4,5  

 Our results in men were of CKD grade 3 in 13.2% and grades 1-2 in 1.6%. In women, 20% with grade 3 and 3.3% with grades 1-2. These data match the most recently reported data on prevalence of kidney disease in patients with diabetes.6 By applying CKD-EPI, 1.2% of women and 2.5% of men had worsened grading (Table 1). If we apply the Bland-Altman graphic method, the results differ from those of Montañés et al.,1 since there is an average discrepancy of 3.5ml/min (4.4%) favouring MDRD in men and 2.6ml/min (1.7%) favouring CKD-EPI in women (Figure 1). However, our concordance study (intraclass correlation coefficient and Lin coefficient) is greater than 98%.  

 These differences may be explained by the application of the classical formula (coefficient 186) rather than MDRD-IDMS (coefficient 175) and for the unequal population studied: PC versus the nephrology referral centre, 55% women vs. 30% and 81% with grades 4-5 vs. 63%.  

 However, on the other hand, the differences are so small that we can say that the new CKD-EPI formulas are tools that are as useful as MDRD and we hope that they will allow us to raise awareness and increase eGFR requests in primary care.  

Table 1. CKD grade classification by MDRD

Figure 1. Bland Altman method for concordance between MDRD and CKD-EPI

Bibliography
[1]
1.-  Montañés R; Bover J; Oliver A; Ballarín JA; Gràcia S. Valoración de la   nueva ecuación CKD-EPI para la estimación del filtrado glomerular. http://www.revistanefrologia.com/prepublicaciones
[2]
2.-  Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9):604-12. [Pubmed]
[3]
- Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130:461-70.
[4]
- Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145(4): 247-54 [Pubmed]
[5]
5.- Gracia S, Montañés R, Bover J, Cases A, Deulofeu R, Martín de Francisco L, et al. Documento de consenso: Recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en adultos. Nefrología 2006; 26(6):658-65. [Pubmed]
[6]
6.- Rodríguez-Poncelas A, et al. Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2. MedClin (Barc) 2010.doi:10.1016/j.medcli.2009.06.069 (prepublicación)
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