Accuracy of modification of diet for renal disease and Cockcroft-Gault equations as compared to the radioisotope double sample method: A study in patients with acute renal failure

Document Type : Original Article

Authors

1 Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: We intended to assess the accuracy of re-expressed Modification of Diet for Renal Disease (MDRD) and Cockcroft-Gault (CG) equations to estimate glomerular filtration rate (GFR) in chronic kidney disease in two different etiologies of acute renal failure (ARF): acute tubular necrosis (ATN) and acute glomerulonephritis (AGN).
Methods: Patients admitted for ARF or the patients complicated with ARF during the course of their hospitalization were enrolled to the study (n=21; 14 females and 7 males; 11 ATN and 12 AGN). When the plasma creatinine reached a steady state (DPSM) using 99mTc-DTPA. GFR was also estimated by MDRD (GFRMDRD) and CG (GFRCG) equations.
Results: The patients aged 44.8±19.5 years and weighted 67.8±10.7kg. GFRDPSM (32.9±14.7 ml/min) was statistically different from the GFRMDRD (11.6±8.2 ml/min; pCG was lower than GFRDPSM in patients with either ATN (16.5±12.5ml/min and pDPSM and GFRMDRD (r=0.34; p=0.13) but GFRDPSM and GFRCG values were correlated (r=0.48; p=0.03). Out of subjects with GFRDPSM >30, 92.3% had GFRMDRDCG

Conclusion: Our results indicate that MDRD and CG equations were substantially inaccurate in patients with ARF.   More precise methods of GFR evaluation is recommended in these patients.

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Assadi M, Eftekhari M, Hozhabrosadati M, Saghari M, Ebrahimi A, Nabipour I, Abbasi MZ, Moshtaghi D, Abbaszadeh M, Assadi S. Comparison of methods for determination of glomerular filtration rate: low and high-dose Tc-99m-DTPA renography, predicted creatinine clearance method, and plasma sample method. Int Urol Nephrol. 2008;40(4):1059-65.
Cirillo M. Evaluation of glomerular filtration rate and of albuminuria/proteinuria. J Nephrol. 2010 Mar-Apr;23(2):125-32.
Ho E, Teo BW. Assessing kidney function in Asia. Singapore Med J. 2010 Nov;51(11):888-93.
Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008 Apr;23(4):1203-10.
Bagshaw SM, George C, Bellomo R; ANZICS Database Management Committee. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care. 2008;12(2):R47.
Pickering JW, Endre ZH. Back-calculating baseline creatinine with MDRD misclassifies acute kidney injury in the intensive care unit. Clin J Am Soc Nephrol. 2010 Jul;5(7):1165-73.
Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol. 2010 Jun;5(6):1003-9.
Rigalleau V, Lasseur C, Perlemoine C, Barthe N, Raffaitin C, Chauveau P, Combe C, Gin H. Cockcroft-Gault formula is biased by body weight in diabetic patients with renal impairment. Metabolism. 2006 Jan;55(1):108-12.
White CA, Huang D, Akbari A, Garland J, Knoll GA. Performance of creatinine-based estimates of GFR in kidney transplant recipients: a systematic review. Am J Kidney Dis. 2008 Jun;51(6):1005-15.
Gates GF. Filtration fraction and its implications for radionuclide renography using diethylenetriaminepentaacetic acid and mercaptoacetyltriglycine. Clin Nucl Med. 2004 Apr;29(4):231-7.
Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983 Feb;74(2):243-8.
Bellomo R. Defining, quantifying, and classifying acute renal failure. Crit Care Clin. 2005 Apr;21(2):223-37.
Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005 Jan 29-Feb 4;365(9457):417-30.
Dubovsky EV, Russell CD, Bischof-Delaloye A, Bubeck B, Chaiwatanarat T, Hilson AJ, Rutland M, Oei HY, Sfakianakis GN, Taylor A Jr. Report of the Radionuclides in Nephrourology Committee for evaluation of transplanted kidney (review of techniques). Semin Nucl Med. 1999 Apr;29(2):175-88.
Anderson RJ, Schrier RW. Clinical spectrum of oliguric and nonoliguric renal failure. In: Brenner BM, Stein JH. Acute Renal Failure. New York: Churchill Livingston; 1980.
Mariat C, Alamartine E, Barthelemy JC, De Filippis JP, Thibaudin D, Berthoux P, Laurent B, Thibaudin L, Berthoux F. Assessing renal graft function in clinical trials: can tests predicting glomerular filtration rate substitute for a reference method? Kidney Int. 2004 Jan;65(1):289-97.
Barroso S, Martínez JM, Martín MV, Rayo I, Caravaca F. Accuracy of indirect estimates of renal function in advanced chronic renal failure patients. Nefrologia. 2006;26(3):344-50.
Abefe SA, Abiola AF, Olubunmi AA, Adewale A. Utility of predicted creatinine clearance using MDRD formula compared with other predictive formulas in Nigerian patients. Saudi J Kidney Dis Transpl. 2009 Jan;20(1):86-90.
Itoh K. Comparison of methods for determination of glomerular filtration rate: Tc-99m-DTPA renography, predicted creatinine clearance method and plasma sample method. Ann Nucl Med. 2003 Oct;17(7):561-5.
Li HX, Xu GB, Wang XJ, Zhang XC, Yang JM. Diagnostic accuracy of various glomerular filtration rates estimating equations in patients with chronic kidney disease and diabetes. Chin Med J (Engl). 2010 Mar 20;123(6):745-51.
Solerte SB, Fioravanti M, Schifino N, Ferrari E. Effects of diet-therapy on urinary protein excretion albuminuria and renal haemodynamic function in obese diabetic patients with overt nephropathy. Int J Obes. 1989;13(2):203-11.
Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care. 2000 Oct;23(10):1499-504.
Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988 Jun;84(6):1053-60.
van de Ree MA, Christiaan G, Huisman MV, van der Vijver JC, Meinders AE. Monitoring renal function in obese patients with type 2 diabetes mellitus in daily practice. Diabetes Nutr Metab. 2001 Apr;14(2):66-70.
 Waller DG, Fleming JS, Ramsey B, Gray J. The accuracy of creatinine clearance with and without urine collection as a measure of glomerular filtration rate. Postgrad Med J. 1991 Jan;67(783):42-6.
Gault MH, Longerich LL, Harnett JD, Wesolowski C. Predicting glomerular function from adjusted serum creatinine. Nephron. 1992;62(3):249-56.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12.