Overview As to Diseases, Make a Habit of Two Things a€” To Help, or at Least Do No Harm

摘要

Clase et al. recently questioned a recommendation that clinical laboratories report a GFR value calculated by either the Cockcroft-Gault or the MDRD equation, when a serum creatinine (Scr) is ordered (1,2). The calculated GFR is intended to increase the early recognition and treatment of chronic kidney disease (CKD). Their concern is based on their calculation of Cockcroft-Gault and MDRD estimates of GFR for a representative, cross-sectional sample of the nondiabetic adult population of the United States (2). They found that estimates of CKD prevalence, defined as a GFR of less than 80 ml/min per 1.73 m2, predicted by the MDRD equation varied between 29.1% for black men to 68% for white women. Cockcroft-Gault prevalence estimates ranged between 25% for white men and 53% for white women. The MDRD equation consistently predicted a greater prevalence of CKD for whites compared with blacks, whereas the Cockcroft-Gault equation predicted a higher prevalence for white women compared with black women and the converse among men. These race-specific patterns were preserved when CKD was stratified into mild (60 to 79 ml/min), moderate (30 to 59 ml/min), and severe (30 ml/min) levels of function.