GFR estimating equations, CKD prevalence and the public health.

摘要

In 2002, the US National Kidney Foundation released clinical practice guidelines [the Kidney Disease Outcomes Quality Initiative (K/DOQI)] aimed at standardizing and simplifying the definition of chronic kidney disease (CKD). These guidelines classify CKD in part by glomerular filtration rate (GFR) estimated either by the Cockcroft-Gault or the Modification of Diet in Renal Disease (MDRD) study equations. The Cockcroft-Gault formula was derived from 249 mostly male Canadians [1] and the MDRD equation from 1628 mostly white study subjects with measured GFR by iothalamate of 22-55 mL min~(-1) 1.73m~(-2) [2]. The wisdom of applying an equation derived within a population with moderate to advanced CKD to the general population is debatable, yet the MDRD equation nonetheless has become the 'industry standard' for estimating GFR, as evidenced by its widespread application in clinical research and its routine reporting in many laboratories.