The Journal of Practical Medicine >
The precision and accuracy of five equations for estimated glomerular filtration rate in evaluating renal function in critically ill patients
Received date: 2024-11-27
Online published: 2025-04-30
Objective To evaluate and compare the performance of the Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation， the abbreviated Modification of Diet in Renal Disease （aMDRD） equation， the Cockroft-Gault （C-G） formula， the Mayo Clinic Quadratic （MCQ） equation， and the Berlin Initiative Study 1 （BIS1） equation in determining renal function among critically ill patients， and to identify the most appropriate method for clinical application. Methods Critically ill patients admitted to the Intensive Care Units of the Department of Geriatric Medicine at the First Affiliated Hospital of Nanjing Medical University （Jiangsu Province Hospital） between June 2020 and June 2022 were included. Their renal function was assessed within 48 hours of admission using the 24-hour creatinine clearance rate （CrCl24h） as the reference standard， and compared with the CKD-EPI equation， aMDRD equation， C-G formula， MCQ equation， and BIS1 equation. The precision and accuracy of each equation in evaluating renal function in critically ill patients were analyzed. Results Total of 534 patients were included in the study. （1） The aMDRD equation exhibited the least bias （-3.91）， yet the accuracy of the five estimated glomerular filtration rate （eGFR） equations was relatively low， ranging from 42.9% to 63.1%. （2） For renal function grading， the weighted κ agreement values between the CKD-EPI equation， aMDRD equation， C-G formula， MCQ equation， BIS1 equation， and CrCl24h were 0.464， 0.555， 0.403， 0.405， and 0.159， respectively （all P < 0.001）. （3） Among patients with severe kidney function decline ［CrCl24h ≤ 60 mL/（min·1.73 m2）］， the eGFR value derived from the C-G formula was the lowest， while that from the BIS1 equation was the highest. In patients with normal or moderately reduced renal function ［60 mL/（min·1.73 m2）< CrCl24h ≤ 130 mL/（min·1.73 m2）］， the eGFR value of the C-G formula remained the lowest， whereas the MCQ equation yielded the highest eGFR value. For patients with augmented renal function ［CrCl24h > 130 mL/（min·1.73 m2）］， the eGFR value of the BIS1 equation was the lowest， and the aMDRD equation produced the highest eGFR value. （4） When renal function was severely decreased or augmented ［CrCl24h > 130 mL/（min·1.73 m2）］， the accuracy of the CKD-EPI and MCQ equations declined. Conversely， as creatinine clearance increased， the accuracy of the aMDRD equation improved gradually. The C-G formula demonstrated an opposite trend compared to the aMDRD equation， and the BIS1 equation exhibited low accuracy across all groups. （5） The optimal critical values ［mL/（min·m2）］ for diagnosing augmented renal clearance （ARC） using the five eGFR equations were as follows： eGFRCKD-EPI： 91.1， eGFRaMDRD： 99.84， eGFRC-G： 76.27， eGFRMCQ： 100.87， eGFRBIS1： 82.36. Conclusions The precision and accuracy of the five eGFR equations are relatively low， making them unsuitable for assessing renal function in critically ill patients. Collecting 24-hour urine to calculate creatinine clearance remains an essential method for evaluating renal function in this population. In the absence of early CrCl24h data upon ICU admission， the cut-off values of the eGFR equations may serve as a tool for the early identification of ARC. Additionally， the aMDRD equation can provide a rough estimate of creatinine clearance in critically ill patients.
Hanjie ZENG , Min HUANG , Qian ZHANG , Dongmei ZHU , Suming. ZHOU . The precision and accuracy of five equations for estimated glomerular filtration rate in evaluating renal function in critically ill patients[J]. The Journal of Practical Medicine, 2025 , 41(8) : 1243 -1252 . DOI: 10.3969/j.issn.1006-5725.2025.08.023
| 1 | BELLOMO R， KELLUM J A， RONCO C， et al. Acute kidney injury in sepsis ［J］. Intensive Care Med， 2017， 43（6）：816-828. doi:10.1007/s00134-017-4755-7 |
| 2 | VAARA S T， BHATRAJU P K， STANSKI N L， et al. Subphenotypes in acute kidney injury： A narrative review ［J］. Crit Care， 2022， 26（1）：251. doi:10.1186/s13054-022-04121-x |
| 3 | COOK A M， HATTON-KOLPEK J. Augmented Renal Clearance ［J］. Pharmacotherapy， 2019， 39（3）： 346-354. doi:10.1002/phar.2231 |
| 4 | HUANG C Y， GüIZA F， DE VLIEGER G， et al. Daily fluctuations in kidney function in critically ill adults ［J］. Crit Care， 2022， 26（1）： 347. doi:10.1186/s13054-022-04226-3 |
| 5 | WARWICK J， HOLNESS J. Measurement of Glomerular Filtration Rate ［J］. Semin Nucl Med， 2022， 52（4）：453-466. doi:10.1053/j.semnuclmed.2021.12.005 |
| 6 | LEVEY A S， STEVENS L A， SCHMID C H， et al. A new equation to estimate glomerular filtration rate ［J］. Ann Intern Med， 2009， 150（9）： 604-612. doi:10.7326/0003-4819-150-9-200905050-00006 |
| 7 | LEVEY A S， CORESH J， BOLTON K， et al. K/DOQI clinical practice guidelines for chronic kidney disease： Evaluation， classification， and stratification ［J］. Am J Kidney Dis， 2002， 39（2 ）： S1-S266. |
| 8 | LEVEY A S， BOSCH J P， LEWIS J B， et al. A more accurate method to estimate glomerular filtration rate from serum creatinine： A new prediction equation. Modification of Diet in Renal Disease Study Group ［J］. Ann Intern Med， 1999， 130（6）： 461-470. doi:10.7326/0003-4819-130-6-199903160-00002 |
| 9 | COCKCROFT D W， GAULT M H. Prediction of creatinine clearance from serum creatinine ［J］. Nephron， 1976， 16（1）： 31-41. doi:10.1159/000180580 |
| 10 | ROSTOKER G， ANDRIVET P， PHAM I， et al. A modified Cockcroft-Gault formula taking into account the body surface area gives a more accurate estimation of the glomerular filtration rate ［J］. J Nephrol， 2007， 20（5）： 576-585. |
| 11 | RIGALLEAU V， LASSEUR C， RAFFAITIN C， et al. The Mayo Clinic quadratic equation improves the prediction of glomerular filtration rate in diabetic subjects ［J］. Nephrol Dial Transplant， 2007， 22（3）： 813-818. doi:10.1093/ndt/gfl649 |
| 12 | SCHAEFFNER E S， EBERT N， DELANAYE P， et al. Two novel equations to estimate kidney function in persons aged 70 years or older ［J］. Ann Intern Med， 2012， 157（7）：471-481. doi:10.7326/0003-4819-157-7-201210020-00003 |
| 13 | GOODBRED A J， LANGAN R C. Chronic Kidney Disease： Prevention， Diagnosis， and Treatment ［J］. Am Fam Physician， 2023， 108（6）：554-561. |
| 14 | GIJSEN M， WILMER A， MEYFROIDT G， et al. Can augmented renal clearance be detected using estimators of glomerular filtration rate？ ［J］. Crit Care， 2020， 24（1）：359. doi:10.1186/s13054-020-03057-4 |
| 15 | VOLBEDA M， HESSELS L， POSMA R A， et al. Time courses of urinary creatinine excretion， measured creatinine clearance and estimated glomerular filtration rate over 30 days of ICU admission ［J］. J Crit Care， 2021， 63：161-166. doi:10.1016/j.jcrc.2020.09.017 |
| 16 | WONGPRAPHAIROT S， THONGRUEANG A， BHURAYANONTACHAI R. Glomerular filtration rate correlation and agreement between common predictive equations and standard 24-hour urinary creatinine clearance in medical critically ill patients ［J］. PeerJ， 2022， 10：e13556. doi:10.7717/peerj.13556 |
| 17 | DECLERCQ P， GIJSEN M， MEIJERS B， et al. Reliability of serum creatinine-based formulae estimating renal function in non-critically ill surgery patients： Focus on augmented renal clearance ［J］. J Clin Pharm Ther， 2018， 43（5）：695-706. doi:10.1111/jcpt.12695 |
| 18 | CARLIER M， DUMOULIN A， JANSSEN A， et al. Comparison of different equations to assess glomerular filtration in critically ill patients ［J］. Intensive Care Med， 2015， 41（3）：427-435. doi:10.1007/s00134-014-3641-9 |
| 19 | GROOTAERT V， WILLEMS L， DEBAVEYE Y， et al. Augmented renal clearance in the critically ill： How to assess kidney function ［J］. Ann Pharmacother， 2012， 46（7-8）：952-959. doi:10.1345/aph.1q708 |
| 20 | ESTEVES F P， HALKAR R K， ISSA M M， et al. Comparison of camera-based 99mTc-MAG3 and 24-hour creatinine clearances for evaluation of kidney function ［J］. AJR Am J Roentgenol， 2006， 187（3）： W316-W319. doi:10.2214/ajr.05.1025 |
| 21 | DU BOIS D， DU BOIS E F. A formula to estimate the approximate surface area if height and weight be known. 1916 ［J］. Nutrition， 1989， 5（5）： 303-311； discussion 312-313. |
| 22 | HEFNY F， STUART A， KUNG J Y， et al. Prevalence and Risk Factors of Augmented Renal Clearance： A Systematic Review and Meta-Analysis ［J］. Pharmaceutics， 2022， 14（2）：445. doi:10.3390/pharmaceutics14020445 |
| 23 | Disease Kidney ： Improving Global Outcomes （KDIGO） CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease ［J］. Kidney Int， 2024， 105（4S）：S117-S314. |
| 24 | HOSTE E A J， KELLUM J A， SELBY N M， et al. Global epidemiology and outcomes of acute kidney injury ［J］. Nat Rev Nephrol， 2018， 14（10）：607-625. doi:10.1038/s41581-018-0052-0 |
| 25 | KELLUM J A， ROMAGNANI P， ASHUNTANTANG G， et al. Acute kidney injury ［J］. Nat Rev Dis Primers， 2021， 7（1）：52. doi:10.1038/s41572-021-00291-0 |
| 26 | MATSUURA R， DOI K， RABB H. Acute kidney injury and distant organ dysfunction-network system analysis ［J］. Kidney Int， 2023， 103（6）：1041-1055. doi:10.1016/j.kint.2023.03.025 |
| 27 | BLANCO V E， HERNANDORENA C V， SCIBONA P， et al. Acute Kidney Injury Pharmacokinetic Changes and Its Impact on Drug Prescription ［J］. Healthcare （Basel）， 2019， 7（1）： 10. doi:10.3390/healthcare7010010 |
| 28 | MORBITZER K A， RHONEY D H， DEHNE K A， et al. Enhanced renal clearance in patients with hemorrhagic stroke ［J］. Crit Care Med， 2019， 47（6）： 800-808. doi:10.1097/ccm.0000000000003716 |
| 29 | CARRIE C， BENTEJAC M， COTTENCEAU V， et al. Association between augmented renal clearance and clinical failure of antibiotic treatment in brain-injured patients with ventilator-acquired pneumonia： A preliminary study ［J］. Anaesth Crit Care Pain Med， 2018， 37（1）： 35-41. doi:10.1016/j.accpm.2017.06.006 |
| 30 | INKER L A， TITAN S. Measurement and Estimation of GFR for Use in Clinical Practice： Core Curriculum 2021 ［J］. Am J Kidney Dis， 2021， 78（5）： 736-749. doi:10.1053/j.ajkd.2021.04.016 |
| 31 | XIE P， HUANG J M， LIN H Y， et al. CKD-EPI equation may be the most proper formula based on creatinine in determining glomerular filtration rate in Chinese patients with chronic kidney disease ［J］. Int Urol Nephrol， 2013， 45（4）： 1057-1064. doi:10.1007/s11255-012-0325-7 |
| 32 | YAN C， WU B， ZENG M， et al. Comparison of different equations for estimated glomerular filtration rate in Han Chinese patients with chronic kidney disease ［J］. Clin Nephrol， 2019， 91（5）：301-310. doi:10.5414/cn109420 |
| 33 | HU J， XU X， ZHANG K， et al. Comparison of estimated glomerular filtration rates in Chinese patients with chronic kidney disease among serum creatinine-， cystatin-C- and creatinine-cystatin-C-based equations： A retrospective cross-sectional study ［J］. Clin Chim Acta， 2020， 505：34-42. doi:10.1016/j.cca.2020.01.033 |
| 34 | 李浩源， 孙叶丽， 周萍. 肾小球滤过率评估公式的优缺点及适用性 ［J］. 实用医学杂志， 2021， 37（11）： 1494-1498. doi:10.3969/j.issn.1006-5725.2021.11.025 |
| 35 | LEVEY A S， CORESH J， BALK E， et al. National Kidney Foundation practice guidelines for chronic kidney disease： Evaluation， classification， and stratification ［J］. Ann Intern Med， 2003， 139（2）： 137-147. doi:10.7326/0003-4819-139-2-200307150-00013 |
| 36 | MACíAS LB， POBLET M S， JEREZ R I， et al. Study of renal function in living kidney donors： Estimated or measured glomerular filtration ［J］. Transplant Proc， 2013， 45（10）：3612-3615. doi:10.1016/j.transproceed.2013.10.022 |
| 37 | RULE A D， LARSON T S， BERGSTRALH E J， et al. Using serum creatinine to estimate glomerular filtration rate： Accuracy in good health and in chronic kidney disease ［J］. Ann Intern Med， 2004， 141（12）： 929-937. doi:10.7326/0003-4819-141-12-200412210-00009 |
| 38 | BEIERWALTES W H， HARRISON-BERNARD L M， SULLIVAN J C， et al. Assessment of Renal Function； Clearance， the Renal Microcirculation， Renal Blood Flow， and Metabolic Balance ［J］. Compr Physiol， 2013， 3（1）： 165-200. doi:10.1002/j.2040-4603.2013.tb00489.x |
| 39 | FONTSERé N， BONAL J， SALINAS I， et al. Is the new Mayo Clinic Quadratic equation useful for the estimation of glomerular filtration rate in type 2 diabetic patients？ ［J］. Diabetes Care， 2008， 31（12）：2265-2267. doi:10.2337/dc08-0958 |
| 40 | XIA F， HAO W， LIANG J， et al. Applicability of Creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients ［J］. BMC Geriatr， 2021，21（1）：481. doi:10.1186/s12877-021-02428-y |
| 41 | BAPTISTA J P， UDY A A， SOUSA E， et al. A comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance ［J］. Crit Care， 2011， 15（3）： R139. doi:10.1186/cc10262 |
/
| 〈 |
|
〉 |