Thursday, March 21, 2013

MDRD vs CKD-EPI in Transplantation

With the results of the eAJKD brackets posted by Gearoid, I thought this article might be pertinent to stimulate further the debate... This article just came out on Transplantation and is a well designed study in which the performance of the CKD-EPI equation is compared with the MDRD Study equation in 825 stable kidney transplant recipients.
GFR was measured by urinary clearance of inulin (n=488) and plasma clearance of 51Cr-EDTA (n=337).
The results showed that bias was significantly lower for MDRD Study equation compared with CKD-EPI creatinine to estimate the GFR. This superiority translated into a better accuracy (80% and 74% for the MDRD and CKD-EPI creatinine, respectively). The best performance of the MDRD Study equation was confirmed both in the subgroups of patients with mGFR below 60 mL/min/1.73 m2 and between 60 and 90 mL/min/1.73 m2. For mGFR above 90 mL/min/1.73 m2, there were no significant differences between the two equations in terms of performance.
The data also bring us back to the main concern about using creatinine and how poor of a marker it is for renal function. About 30% are misclassified in the CKD stages...  The battle is far from over...

1 comment:

Gearoid McMahon said...

Just watched a talk by Mike Shlipak at the AHA-Epi conference. He was pushing the cystatin C formula again and made a convincing argument at least in terms of ability to predict adverse events.