Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent

Overview

Journal Medicines (Basel)

Specialty Pharmacology

Date 2021 Sep 26

PMID 34564090

Citations 1

Authors

Marlene Tapper

Donovan A McGrowder

Lowell Dilworth

Adedamola Soyibo

Affiliations

Soon will be listed here.

Abstract

Background: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative.

Method: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined.

Results: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (-0.05).

Conclusion: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

Citing Articles

Diagnostic Accuracy of Creatinine-Based Equations for eGFR Estimation in Pakistanis: Evaluation of the European Kidney Function Consortium Equation vs the CKD-EPI Pakistan Equation.

Ahmed S, Subash T, Ahmed H, Sadiqa A, Yaqub S, Jafri L EJIFCC. 2025; 35(4):285-293.

PMID: 39810889 PMC: 11726330.

Exploring Adiposity and Chronic Kidney Disease: Clinical Implications, Management Strategies, Prognostic Considerations.

Ozbek L, Abdel-Rahman S, Unlu S, Guldan M, Copur S, Burlacu A Medicina (Kaunas). 2024; 60(10).

PMID: 39459455 PMC: 11509396. DOI: 10.3390/medicina60101668.

References

Traynor J, Mactier R, Geddes C, Fox J . How to measure renal function in clinical practice. BMJ. 2006; 333(7571):733-7. PMC: 1592388. DOI: 10.1136/bmj.38975.390370.7C. View

Verhave J, Gansevoort R, Hillege H, de Zeeuw D, Curhan G, de Jong P . Drawbacks of the use of indirect estimates of renal function to evaluate the effect of risk factors on renal function. J Am Soc Nephrol. 2004; 15(5):1316-22. View

Kuan Y, Hossain M, Surman J, El Nahas A, Haylor J . GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease. Nephrol Dial Transplant. 2005; 20(11):2394-401. DOI: 10.1093/ndt/gfi076. View

Soyibo A, Barton E . Report from the Caribbean renal registry, 2006. West Indian Med J. 2008; 56(4):355-63. View

Roy D, Chowdhury A, Roy A, Ahammed S, Asadujjaman M, Rabbani M . Correlation of eGFR By MDRD and CKD-EPI Formula with Creatinine Clearance Estimation in CKD Patients and Healthy Subjects. Mymensingh Med J. 2021; 30(1):35-42. View

Stevens L, Coresh J, Greene T, Levey A . Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2006; 354(23):2473-83. DOI: 10.1056/NEJMra054415. View

Witte E, Lambers Heerspink H, de Zeeuw D, Bakker S, de Jong P, Gansevoort R . First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol. 2008; 20(2):436-43. PMC: 2637059. DOI: 10.1681/ASN.2008030292. View

Banfi G, Fabbro M . Serum creatinine values in elite athletes competing in 8 different sports: comparison with sedentary people. Clin Chem. 2006; 52(2):330-1. DOI: 10.1373/clinchem.2005.061390. View

Delanghe J, Speeckaert M . Creatinine determination according to Jaffe-what does it stand for?. NDT Plus. 2015; 4(2):83-6. PMC: 4421578. DOI: 10.1093/ndtplus/sfq211. View

10.

Schwartz G, Work D . Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009; 4(11):1832-43. DOI: 10.2215/CJN.01640309. View

11.

Zou L, Sun L, Nicholas S, Lu Y, K S, Hua R . Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation. Eur J Intern Med. 2020; 80:29-34. DOI: 10.1016/j.ejim.2020.04.044. View

12.

. Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011). 2014; 3(1):19-62. PMC: 4089693. DOI: 10.1038/kisup.2012.64. View

13.

Soyibo A, Barton E . Chronic renal failure from the English-speaking Caribbean: 2007 data. West Indian Med J. 2010; 58(6):596-600. View

14.

van Deventer H, Paiker J, Katz I, George J . A comparison of cystatin C- and creatinine-based prediction equations for the estimation of glomerular filtration rate in black South Africans. Nephrol Dial Transplant. 2010; 26(5):1553-8. PMC: 3108353. DOI: 10.1093/ndt/gfq621. View

15.

Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P . Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol. 2005; 16(3):763-73. DOI: 10.1681/ASN.2004070549. View

16.

Gansevoort R, Correa-Rotter R, Hemmelgarn B, Jafar T, Lambers Heerspink H, Mann J . Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013; 382(9889):339-52. DOI: 10.1016/S0140-6736(13)60595-4. View

17.

Srivastava T, Alon U, Althahabi R, Garg U . Impact of standardization of creatinine methodology on the assessment of glomerular filtration rate in children. Pediatr Res. 2008; 65(1):113-6. DOI: 10.1203/PDR.0b013e318189a6e8. View

18.

Levey A, Bosch J, Lewis J, 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(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

19.

Vickery S, Stevens P, Dalton R, Van Lente F, Lamb E . Does the ID-MS traceable MDRD equation work and is it suitable for use with compensated Jaffe and enzymatic creatinine assays?. Nephrol Dial Transplant. 2006; 21(9):2439-45. DOI: 10.1093/ndt/gfl249. View

20.

Lewis J, Agodoa L, Cheek D, Greene T, Middleton J, OConnor D . Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis. 2001; 38(4):744-53. DOI: 10.1053/ajkd.2001.27691. View