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Background Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher levels. Objective To develop a new estimating equation (CKD-EPI creatinine equation). Design Cross-sectional analysis. Separate pooled databases for equation development and validation. Representative U.S. population for prevalence estimates. Setting Research studies and clinical populations (“studies”) with measured GFR. National Health and Nutrition Examination Survey (NHANES) 1999-2006. Patients Equation development in 10 studies (8254 people) and validation in 16 studies (3896 people). Prevalence estimates based on 16,032 people. Measurements GFR measured as the clearance of exogenous filtration markers (iothalamate in the development dataset; iothalamate and other markers in the validation dataset). Linear regression to estimate the logarithm of measured GFR from standardized creatinine, sex, race and age. Results In the validation dataset, the CKD-EPI performed better than the MDRD Study equation (p\textless0.001 for all subsequent comparisons), especially at higher GFR: lesser bias (median difference between measured and estimated GFR of 2.5 vs. 5.5 mL/min/1.73 m2, respectively); improved precision (interquartile range of the differences of 16.6 vs. 18.3 mL/min/1.73 m2, respectively); and greater accuracy (percent of estimated GFR within 30% of measured GFR of 84.1 vs. 80.6%, respectively. In NHANES, median (interquartile range) estimated GFR was 94.5 (79.7 – 108.1) vs. 85.0 (72.9 – 98.5) mL/min/1.73 m2, and the prevalence (95% confidence interval) of CKD was 11.5 (10.6, 12.4) % vs. 13.1 (12.1, 14.0) %, respectively. Limitations Limited number of elderly people and racial and ethnic minorities with measured GFR. Conclusions The CKD-EPI creatinine equation is more accurate than the MDRD Study equation and could replace it for routine clinical use.

@article{levey_new_2009, title = {A {New} {Equation} to {Estimate} {Glomerular} {Filtration} {Rate}}, volume = {150}, issn = {0003-4819}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763564/}, abstract = {Background Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher levels. Objective To develop a new estimating equation (CKD-EPI creatinine equation). Design Cross-sectional analysis. Separate pooled databases for equation development and validation. Representative U.S. population for prevalence estimates. Setting Research studies and clinical populations (“studies”) with measured GFR. National Health and Nutrition Examination Survey (NHANES) 1999-2006. Patients Equation development in 10 studies (8254 people) and validation in 16 studies (3896 people). Prevalence estimates based on 16,032 people. Measurements GFR measured as the clearance of exogenous filtration markers (iothalamate in the development dataset; iothalamate and other markers in the validation dataset). Linear regression to estimate the logarithm of measured GFR from standardized creatinine, sex, race and age. Results In the validation dataset, the CKD-EPI performed better than the MDRD Study equation (p{\textless}0.001 for all subsequent comparisons), especially at higher GFR: lesser bias (median difference between measured and estimated GFR of 2.5 vs. 5.5 mL/min/1.73 m2, respectively); improved precision (interquartile range of the differences of 16.6 vs. 18.3 mL/min/1.73 m2, respectively); and greater accuracy (percent of estimated GFR within 30\% of measured GFR of 84.1 vs. 80.6\%, respectively. In NHANES, median (interquartile range) estimated GFR was 94.5 (79.7 – 108.1) vs. 85.0 (72.9 – 98.5) mL/min/1.73 m2, and the prevalence (95\% confidence interval) of CKD was 11.5 (10.6, 12.4) \% vs. 13.1 (12.1, 14.0) \%, respectively. Limitations Limited number of elderly people and racial and ethnic minorities with measured GFR. Conclusions The CKD-EPI creatinine equation is more accurate than the MDRD Study equation and could replace it for routine clinical use.}, number = {9}, urldate = {2018-06-25TZ}, journal = {Annals of internal medicine}, author = {Levey, Andrew S. and Stevens, Lesley A. and Schmid, Christopher H. and Zhang, Yaping (Lucy) and Castro, Alejandro F. and Feldman, Harold I. and Kusek, John W. and Eggers, Paul and Van Lente, Frederick and Greene, Tom and Coresh, Josef}, month = may, year = {2009}, pmid = {19414839}, pmcid = {PMC2763564}, pages = {604--612} }

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