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Observations from a teaching hospital in Ireland: changing from MDRD to CKD-EPI eGFR in routine practice
  1. Janice Lee Veronica Reeve1,
  2. Marion Davis1,
  3. Patrick Joseph Twomey1,2
  1. 1Clinical Chemistry, St. Vincent's University Hospital, Dublin, Dublin, Ireland
  2. 2School of Medicine, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Janice Lee Veronica Reeve, Clinical Chemistry, St Vincent's University Hospital, Dublin 4, Ireland; j.reeve{at}svuh.ie

Abstract

Estimates of glomerular filtration rate (eGFR) help assess kidney function. Estimated GFR can be used to classify patients into one of six Chronic Kidney Disease (CKD) categories as recommended by the Kidney Disease Improving Global Outcomes clinical practice guidelines; CKD1 ≥90, CKD2 60–89, CKD3a 45–59, CKD3b 30–44, CKD4 15–29 or CKD5 ≤15 mL/min/1.73 m2. The Modification of Diet and Renal Disease (MDRD) study formula was widely adopted to calculate eGFR. The CKD Epidemiology Collaboration (CKD-EPI) formula improved accuracy of CKD staging at eGFR ≥60 mL/min/1.73 m2. MDRD and CKD-EPI eGFR were calculated on 111 444 serum creatinine results from adult patients measured as part of the routine Clinical Chemistry service. Application of CKD-EPI eGFR reclassified 18% to a lower (13.9%) or higher (4.0%) CKD stage. CKD staging was lower when <65 years and higher when ≥65 years. Females were more often reclassified compared with males (2.6% vs 0.8%). Overall, CKD-EPI eGFR classified less with CKD (stages 3a-5), unless ≥75 years. Older males and inpatients had higher CKD stages when CKD-EPI eGFR was applied. It has been recommended to replace MDRD eGFR with CKD-EPI eGFR. In general, doing this will have little impact, however, for some patients their CKD classification will be different.

  • glomerular filtration rate
  • chemistry
  • clinical
  • kidney
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Footnotes

  • Handling editor Tahir S Pillay.

  • Contributors JLVR and MD implemented use of CKD-EPI eGFR. JLVR collected and analysed the laboratory data. JLVR and PJT interpreted the data. JLVR drafted the manuscript with critical input from PJT. All authors reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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