J Korean Med Sci.  2010 Nov;25(11):1616-1625. 10.3346/jkms.2010.25.11.1616.

Ethnic Coefficients for Glomerular Filtration Rate Estimation by the Modification of Diet in Renal Disease Study Equations in the Korean Population

• Lee CS
• Cha RH
• Lim YH
• Kim H
• Song KH
• Gu N
• Yu KS
• Lim CS
• Han JS
• Kim S
• Kim YS

• KMID: 1779232
• DOI: http://doi.org/10.3346/jkms.2010.25.11.1616

Abstract

Race and ethnicity are influential in estimating glomerular filtration rate (GFR). We aimed to find the Korean coefficients for the Modification of Diet in Renal Disease (MDRD) study equations and to obtain novel proper estimation equations. Reference GFR was measured by systemic inulin clearance. Serum creatinine (SCr) values were measured by the alkaline picrate Jaffe kinetic method, then, recalibrated to CX3 analyzer and to isotope dilution mass spectrometry (IDMS). The Korean coefficients for the 4 and 6 variable MDRD and IDMS MDRD study equations based on the SCr recalibrated to CX3 and to IDMS were 0.73989/0.74254 and 0.99096/0.9554, respectively. Coefficients for the 4 and 6 variable MDRD equations based on the SCr measured by Jaffe method were 1.09825 and 1.04334, respectively. The modified equations showed better performances than the original equations. The novel 4 variable equations for Korean based on the SCr measured and recalibrated to IDMS were 107.904xSCr-1.009xage-0.02 (x0.667, if woman) and 87.832xSCr-0.882xage0.01 (x0.653, if woman), respectively. Modified estimations of the MDRD and IDMS MDRD study equations with ethnic coefficients and the novel equations improve the performance of GFR estimation for the overall renal function.

Keyword

Coefficient; Glomerular Filtration Rate; Inulin Clearance; Modification of Diet in Renal Disease Study

MeSH Terms

Adult
Aged
Aged, 80 and over
Algorithms
Creatinine/blood
*Diet
Female
*Glomerular Filtration Rate
Humans
Inulin/metabolism
Kidney Diseases/*ethnology/physiopathology
Male
Mass Spectrometry
Middle Aged
Republic of Korea/ethnology

Figure

• 

  Fig. 1 Correlation of estimated glomerular filatration rate (eGFR) (equations 1-8) with systemic inulin clearance (reference GFR) (A) and Bland and Altman plots between eGFR (equations 1-8) and systemic inulin clearance (B) (n=147; excluding participants whose reference GFR exceeded 130 mL/min/1.73 m2). (A) Black line: Identical line, gray line: Fit line between systemic inulin clearance and eGFR. Modification of the Modification of Diet in Renal Disease (MDRD) study equations using serum creatinine (SCr) values recalibrated to CX3 analyzer (Cleveland Clinic Reference Laboratory) underestimated GFR for all stages of renal function. (B) Solid red line represents the regression line of difference between methods against average of methods. The mean difference is indicated by center line, limits of agreement are indicated by the upper (mean+2SD) and lower (mean-2SD) lines. Eq1-Eq4: Equations 1-4: The MDRD and Isotope Dilution Mass Spectrometry (IDMS) MDRD study equations using SCr values recalibrated to CX3 analyzer and to IDMS. Eq5-Eq8: Equations 1-4 multiplied by the Korean ethnic coefficients.

• 

  Fig. 2 Correlation of estimated glomerular filatration rate (eGFR) (equations 9-14) with systemic inulin clearance (reference GFR) (A) and Bland and Altman plots between eGFR (equations 9-14) and systemic inulin clearance (B) (n=147; excluding participants whose reference GFR exceeded 130 mL/min/1.73 m2). (A) Black line: Identical line, gray line: Fit line between systemic inulin clearance and eGFR. Overestimation in advanced renal dysfunction or underestimation in near normal renal function was still observed. (B) Solid red line represents the regression line of difference between methods against average of methods. The mean difference is indicated by center line, limits of agreement are indicated by the upper (mean+2SD) and lower (mean-2SD) lines. Eq9-Eq10: The Modification of Diet in Renal Disease (MDRD) study equations using locally measured serum creatinine (SCr) values by a Hitachi 7600 and multiplied by the Korean ethnic coefficients. Eq11-Eq14: Novel 4 and 6 variable equations using SCr values recalibrated to CX3 analyzer (equations 11 and 12) and to Isotope Dilution Mass Spectrometry (IDMS) (equations 13 and 14).

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