Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae
Introduction: Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EPI formulae on prevalence estimates, and on secular t...
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| Veröffentlicht in: | QJM : An International Journal of Medicine 2011-12, Vol.104 (12), p.1045-1053 |
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| creator | Gifford, F.J. Methven, S. Boag, D.E. Spalding, E.M. MacGregor, M.S. |
| description | Introduction: Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EPI formulae on prevalence estimates, and on secular trends in prevalence.
Methods: We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009-10). To minimize the effect of acute illness, a patient's lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with sub-group analysis by age and sex.
Results: In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009-10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3-5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60-89 ml/min/1.73m2 and CKD stage 3A, in women, and in those |
| doi_str_mv | 10.1093/qjmed/hcr122 |
| format | Article |
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Methods: We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009-10). To minimize the effect of acute illness, a patient's lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with sub-group analysis by age and sex.
Results: In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009-10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3-5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60-89 ml/min/1.73m2 and CKD stage 3A, in women, and in those <70 years old. 5172 patients (1.8%), mostly elderly women, were reclassified to more severe stages of CKD. Between the two time periods, the prevalence of CKD stages 3-5 rose from 5.44% to 5.63% of the population using MDRD4, but was static at 4.94% with CKD-EPI.
Conclusion: The CKD-EPI formulae, which are more accurate than the MDRD4 formula at higher GFR, reduced the estimated prevalence of CKD stages 3-5 by 0.5% in 2004 and 0.7% in 2009-10. The greatest reclassification was seen in CKD 3A, particularly amongst middle-aged females. The minor rise in CKD prevalence between 2004 and 2009-10 seen with the MDRD4 formula was not confirmed with the CKD-EPI formulae. The CKD-EPI formulae may reduce overdiagnosis of CKD, but further assessment in the elderly is required before widespread implementation.</description><identifier>ISSN: 1460-2725</identifier><identifier>EISSN: 1460-2393</identifier><identifier>DOI: 10.1093/qjmed/hcr122</identifier><identifier>PMID: 21821654</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Biological and medical sciences ; Creatinine - blood ; Epidemiology ; Female ; General aspects ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic - epidemiology ; Kidney Function Tests - methods ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Prevalence ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Scotland - epidemiology ; Urinary system involvement in other diseases. Miscellaneous ; Young Adult</subject><ispartof>QJM : An International Journal of Medicine, 2011-12, Vol.104 (12), p.1045-1053</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-8cf466766d0bfc2318a5e8322c786f41c4e9e899045768d4d45b3c04e52e362d3</citedby><cites>FETCH-LOGICAL-c390t-8cf466766d0bfc2318a5e8322c786f41c4e9e899045768d4d45b3c04e52e362d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25272910$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21821654$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gifford, F.J.</creatorcontrib><creatorcontrib>Methven, S.</creatorcontrib><creatorcontrib>Boag, D.E.</creatorcontrib><creatorcontrib>Spalding, E.M.</creatorcontrib><creatorcontrib>MacGregor, M.S.</creatorcontrib><title>Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae</title><title>QJM : An International Journal of Medicine</title><addtitle>QJM</addtitle><description>Introduction: Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EPI formulae on prevalence estimates, and on secular trends in prevalence.
Methods: We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009-10). To minimize the effect of acute illness, a patient's lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with sub-group analysis by age and sex.
Results: In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009-10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3-5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60-89 ml/min/1.73m2 and CKD stage 3A, in women, and in those <70 years old. 5172 patients (1.8%), mostly elderly women, were reclassified to more severe stages of CKD. Between the two time periods, the prevalence of CKD stages 3-5 rose from 5.44% to 5.63% of the population using MDRD4, but was static at 4.94% with CKD-EPI.
Conclusion: The CKD-EPI formulae, which are more accurate than the MDRD4 formula at higher GFR, reduced the estimated prevalence of CKD stages 3-5 by 0.5% in 2004 and 0.7% in 2009-10. The greatest reclassification was seen in CKD 3A, particularly amongst middle-aged females. The minor rise in CKD prevalence between 2004 and 2009-10 seen with the MDRD4 formula was not confirmed with the CKD-EPI formulae. The CKD-EPI formulae may reduce overdiagnosis of CKD, but further assessment in the elderly is required before widespread implementation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Biological and medical sciences</subject><subject>Creatinine - blood</subject><subject>Epidemiology</subject><subject>Female</subject><subject>General aspects</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Kidney Function Tests - methods</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Prevalence</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Scotland - epidemiology</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Young Adult</subject><issn>1460-2725</issn><issn>1460-2393</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctLxDAQxoMovm-eJRfxYjWvpo032fWFiiJ6LtlkykbbpCat4H9vdXfx5mmGj998M3yD0AElp5Qofvbx1oI9m5tIGVtD21RIkjGu-PqqL1i-hXZSeiOEiEKUm2iL0ZJRmYtt1E3mMXhn8LuzHr6wdQl0AtxF-NQNeANYe4sTmKHREfcRvE3Yeazx6x3uQjfKvQv-HPdzwK7ttOlxqPHD9Hn6Ozm5m2aXT7e4DrEdWdhDG7VuEuwv6y56vbp8mdxk94_Xt5OL-8xwRfqsNLWQspDSklltGKelzqHkjJmilLWgRoCCUiki8kKWVliRz7ghAnIGXDLLd9HxwreL4WOA1FetSwaaRnsIQ6oUKajIFaUjebIgTQwpRairLrpWx6-Kkuon4uo34moR8YgfLo2H2Y-8gleZjsDREtDJ6KaO2huX_rh8_Iii5O_CMHT_r_wGV_CRlg</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Gifford, F.J.</creator><creator>Methven, S.</creator><creator>Boag, D.E.</creator><creator>Spalding, E.M.</creator><creator>MacGregor, M.S.</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111201</creationdate><title>Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae</title><author>Gifford, F.J. ; Methven, S. ; Boag, D.E. ; Spalding, E.M. ; MacGregor, M.S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-8cf466766d0bfc2318a5e8322c786f41c4e9e899045768d4d45b3c04e52e362d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Algorithms</topic><topic>Biological and medical sciences</topic><topic>Creatinine - blood</topic><topic>Epidemiology</topic><topic>Female</topic><topic>General aspects</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney Function Tests - methods</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Prevalence</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Scotland - epidemiology</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gifford, F.J.</creatorcontrib><creatorcontrib>Methven, S.</creatorcontrib><creatorcontrib>Boag, D.E.</creatorcontrib><creatorcontrib>Spalding, E.M.</creatorcontrib><creatorcontrib>MacGregor, M.S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>QJM : An International Journal of Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gifford, F.J.</au><au>Methven, S.</au><au>Boag, D.E.</au><au>Spalding, E.M.</au><au>MacGregor, M.S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae</atitle><jtitle>QJM : An International Journal of Medicine</jtitle><addtitle>QJM</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>104</volume><issue>12</issue><spage>1045</spage><epage>1053</epage><pages>1045-1053</pages><issn>1460-2725</issn><eissn>1460-2393</eissn><abstract>Introduction: Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EPI formulae on prevalence estimates, and on secular trends in prevalence.
Methods: We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009-10). To minimize the effect of acute illness, a patient's lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with sub-group analysis by age and sex.
Results: In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009-10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3-5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60-89 ml/min/1.73m2 and CKD stage 3A, in women, and in those <70 years old. 5172 patients (1.8%), mostly elderly women, were reclassified to more severe stages of CKD. Between the two time periods, the prevalence of CKD stages 3-5 rose from 5.44% to 5.63% of the population using MDRD4, but was static at 4.94% with CKD-EPI.
Conclusion: The CKD-EPI formulae, which are more accurate than the MDRD4 formula at higher GFR, reduced the estimated prevalence of CKD stages 3-5 by 0.5% in 2004 and 0.7% in 2009-10. The greatest reclassification was seen in CKD 3A, particularly amongst middle-aged females. The minor rise in CKD prevalence between 2004 and 2009-10 seen with the MDRD4 formula was not confirmed with the CKD-EPI formulae. The CKD-EPI formulae may reduce overdiagnosis of CKD, but further assessment in the elderly is required before widespread implementation.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21821654</pmid><doi>10.1093/qjmed/hcr122</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Algorithms Biological and medical sciences Creatinine - blood Epidemiology Female General aspects Glomerular Filtration Rate Humans Kidney Failure, Chronic - epidemiology Kidney Function Tests - methods Kidneys Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Prevalence Public health. Hygiene Public health. Hygiene-occupational medicine Scotland - epidemiology Urinary system involvement in other diseases. Miscellaneous Young Adult |
| title | Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae |
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