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|Title: ||Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations|
|Authors: ||Eastwood, John B.|
Kerry, Sally M.
Micah, Frank B.
Boa, Frances G.
Cappuccio, Francesco P.
|Keywords: ||CKD-EPI eGFR|
creatinine clearance measurement
|Issue Date: ||2010|
|Publisher: ||Nephrol Dial Transplant|
|Abstract: ||Background. Equations for estimating glomerular filtration
rate (GFR) have not been validated in Sub-Saharan
African populations, and data on GFR are few.
Methods. GFR by creatinine clearance (Ccr) using 24-hour
urine collections and estimated GFR (eGFR) using the fourvariable
Modification of Diet in Renal Disease (MDRD-4)
[creatinine calibrated to isotope dilution mass spectrometry
(IDMS) standard], Chronic Kidney Disease Epidemiology
Collaboration (CKD-EPI) and Cockcroft–Gault equations
were obtained in Ghanaians aged 40–75. The population
comprised 1013 inhabitants in 12 villages; 944 provided a
serum creatinine and two 24-hour urines. The mean weight
was 54.4 kg; mean body mass index was 21.1 kg/m2.
Results. Mean GFR by Ccr was 84.1 ml/min/1.73 m2;
86.8% of participants had a GFR of ≥60 ml/min/
1.73 m2. Mean MDRD-4 eGFR was 102.3 ml/min/
1.73 m2 (difference vs. Ccr, 18.2: 95% CI: 16.8–19.5);
when the factor for black race was omitted, the value
(mean 84.6 ml/min/1.73 m2) was close to Ccr. Mean
CKD-EPI eGFR was 103.1 ml/min/1.73 m2, and 89.4 ml/
min/1.73 m2 when the factor for race was omitted. The
Cockcroft–Gault equation underestimated GFR compared
with Ccr by 9.4 ml/min/1.73 m2 (CI: 8.3–10.6); particularly
in older age groups. GFR by Ccr, and eGFR by MDRD-4,
CKD-EPI and Cockcroft–Gault showed falls with age:
MDRD-4 5.5, Ccr 7.7, CKD-EPI 8.8 and Cockcroft–Gault
11.0 ml/min/1.73 m2/10 years. The percentage of individuals
identified with CKD stages 3–5 depended on the
method used: MDRD-4 1.6% (7.2 % without factor for
black race; CKD-EPI 1.7% (4.7% without factor for black
race), Ccr 13.2% and Cockcroft–Gault 21.0%.
Conclusions. Mean eGFR by both MDRD-4 and CKD-EPI
was considerably higher than GFR by Ccr and Cockcroft–
Gault, a difference that may be attributable to leanness.
MDRD-4 appeared to underestimate the fall in GFR with
age compared with the three other measurements; the fall
with CKD-EPI without the adjustment for racewas the closest
to that of Ccr. An equation tailored specifically to the
needs of the lean populations of Africa is urgently needed.
For the present, the CKD-EPI equation without the adjustment
for black race appears to be the most useful.|
|Description: ||This article is published in Nephrol Dial Transplant and also available at doi: 10.1093/ndt/gfp765|
|Appears in Collections:||College of Agric and Natural Resources|
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