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A Comparison of Change in Measured and Estimated Glomerular Filtration Rate in Patients with Nondiabetic Kidney Disease

Dawei Xie^*, Marshall M. Joffe^*, Steven M. Brunelli^*,, Gerald Beck, Glenn M. Chertow, Jeffrey C. Fink^||, Tom Greene^¶, Chi-yuan Hsu^**, John W. Kusek, Richard Landis^*, James Lash, Andrew S. Levey, Andrew O’Conner^||||, Akinlolu Ojo^***, Mahboob Rahman, Raymond R. Townsend, Hao Wang^*, and Harold I. Feldman^*,

^* Center for Clinical Epidemiology and Biostatistics and Renal-Electrolyte and Hypertension of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio; Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; ^|| Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland; ^¶ Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; ^** Division of Nephrology, University of California, San Francisco School of Medicine, San Francisco, California; Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland; Division of Nephrology, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts; ^|||| Department of Emergency Medicine, University of Medicine and Denistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, New Jersey; ^*** Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan; and Division of Nephrology and Hypertension, Case Western Reserve University School of Medicine, Cleveland, Ohio

Correspondence: Dr. Harold I. Feldman, Center for Clinical Epidemiology and Biostatistics, 923 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; Phone: 215-898-0901; Fax: 215-898-0643; E-mail: hfeldman{at}mail.med.upenn.edu

Background and objectives: All glomerular filtration rate (GFR) estimating equations have been developed from cross-sectional data. The aims of this study were to examine the concordance between use of measured GFR (mGFR) and estimated GFR (eGFR) in tracking changes in kidney function over time among patients with moderately severe chronic kidney disease.

Design, setting, participants, & measurements: A retrospective cohort study of subjects who had been enrolled in the MDRD Study A and who had two or more contemporaneous assessments of mGFR and eGFR (n = 542; mGFR range, 25 to 55 ml/min per 1.73 m²) during the chronic phase (month 4 and afterwards). mGFR was based on urinary iothalamate clearance; eGFR was based on the 4-variable MDRD Study equation. Temporal changes in GFR were assessed by within-subject linear regression of time on GFR.

Results: Median follow-up time for all subjects was 2.6 yr; median number of GFR measurements was six. The eGFR slope tended to underestimate measured decrements in GFR. The absolute value of the difference in mGFR and eGFR slopes was 2 ml/min per 1.73 m² per yr among 58.3% of subjects; the remainder of subjects had larger absolute differences. Among the 22 variables studied, none predicted a systematic difference between mGFR slope and eGFR slope.

Conclusions: Although eGFR and mGFR exhibited similar relationships to 22 baseline variables, the overall bias seen in the full cohort suggests that clinicians and researchers should exercise caution when interpreting eGFR slope as a marker of progression of kidney disease.