The ideal marker for measuring GFR: what are we looking for?

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Claudio Maioli
Michela Mangano
Ferruccio Conte
Angelo Del Sole
Luca Tagliabue
Federico Alberici
Andrea Galassi
Mario Cozzolino




INTRODUCTION: The most accurate way of assessing kidney function is the measurement of the glomerular filtration rate (GFR). Since, we do not have good formulae to estimate GFR in elderly, in this study we  evaluate the accuracy of the most commonly used formulas for the estimation of GFR in comparison with direct measurement in elderly. MATERIALS AND METHODS: 85 patients (51 males and 34 females), with an average age of 76.2 ± 4.4 years, 42% already diagnosed with chronic kidney disease (CKD) were investigated. Two plasma samples were collected between  60-90 and 165-195 minutes after injection of 99mTc-DTPA, and the GFR was calculated applying Charles D. Russell's two-sample method. RESULTS: When comparing the GFR values obtained from the various formulae by creatinine levels with the GFR values obtained by measuring 99mTc-DTPA residue, the following concordance values emerged: (1) MDRD: 57.5 ± 9.59 %; (2) Cockroft-Gault: 48.33 ± 24.93; (3) CKD-EPI: 49.40 ± 26.30; (4) BIS1: 58 ± 6.79. CONCLUSION: Our data shows a greater concordance between the GFR values calculated with the Russell's method and the estimated values of GFR when the latter are calculated using the MDRD or BIS1 formulae.


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Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008; 8:117.
Cozzolino M, Mangano M, Stucchi A, Ciceri P, Conte F, Galassi A. Cardiovascular disease in dialysis patients. Nephrol Dial Transplant. 2018 Oct 1;33(suppl_3).
Mills KT, Xu Y, Zhang W et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int 2015; 88: 950–957
Van Pottelbergh G, Van Heden L, Matheï C, Degryse J. Methods to evaluate renal function in elderly patients: a systematic literature review. Age Ageing. 2010 Sep;39(5):542-8.
Levey A, Inker L, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis. 2014 May;63(5):820-34
Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO, Melsom T, Lamb EJ, Rule AD, Turner ST, Glassock RJ, De Souza V, Selistre L, Mariat C, Martens F, Delanaye P. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant. 2016 May;31(5):798-806.
Schaeffner E. Determining the Glomerular Filtration Rate-An Overview. J Ren Nutr. 2017 Nov;27(6):375-380. doi: 10.1053/j.jrn.2017.07.005
Ji M, Lee YH, Hur M, Kim H, Cho HI, Yang HS, Navarin S, Di Somma S; GREAT Network. Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations. Ann Lab Med. 2016 Nov;36(6):521-8.
Maioli C, Cozzolino M, Gallieni M, Del Sole A, Tagliabue L, Strinchini A, Gaito S, Lecchi M, Cusi D, Lucignani G. Evaluation of renal function in elderly patients: performance of creatinine-based formulae versus the isotopic method using 99mTc-diethylene triamine pentaacetic acid. Nucl Med Commun. 2014 Apr;35(4):416-22.
Huang Q, Chen Y, Zhang M, Wang S, Zhang W, Cai G, Chen X, Sun X. Comparative evaluation of technetium-99m-diethylenetriaminepentaacetic acid renal dynamic imaging versus the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equation for the estimation of GFR. Int Urol Nephrol. 2018 Apr;50(4):733-743.
Fleming JS, Wilkinson J, Oliver RM, Ackery DM, Blake GM, Waller DG. Comparison of radionuclide estimation of glomerular filtration rate using technetium 99m diethylenetriaminepentaacetic acid and chromium 51 ethylenediaminetetraacetic acid. Eur J Nucl Med 1991; 18:391–395.
Russell CD, Bischoff PG, Kontzen FN, Rowell KL, Yester MV, Lloyd LK, et al. Measurement of glomerular filtration rate: single injection plasma clearance method without urine collection. J Nucl Med 1985; 26:1243–1247
DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight are known. Ann Intern Med 1916; 17:863–871.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16:31–41.
Fliser D, Ritz E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001; 37:79–83.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurements. Lancet 1986; 1:307–310.