Performance of the revised ‘175’ Modification of Diet in Renal Disease equation in patients with type 2 diabetes

Abstract

Aims/hypothesis Estimation of GFR (eGFR) is recommended for the assessment of kidney function in all patients with diabetes. We studied performance of the traditional '186' Modification of Diet in Renal Disease (MDRD) equation, and the 2005 revised '175' MDRD equation in patients with type 2 diabetes. Methods Two hundred and ninety-three mainly normoalbuminuric (267/293) patients were recruited. Patients were classified as having mild renal impairment (group 1, GFR <90 ml min −1 1.73 m −2 ) or normal renal function (group 2, GFR ≥90 ml min −1 1.73 m −2 ). eGFR was calculated by the traditional 186 MDRD equation using traditional creatinine values and the revised 175 MDRD equation using isotope dilution mass spectrometry-standardised creatinine values. Isotopic GFR was measured by the four-sample plasma clearance of 51 Cr-EDTA. Results For patients in group 1, mean±SD isotopic 51 Cr-EDTA GFR (iGFR) was 83.8±4.3 ml min −1 1.73 m −2 , and eGFR was 73.2±11.9 and 75.8±13.7 ml min −1 1.73 m −2 using the 186 and 175 MDRD equations, respectively. Method bias was −10.6 with the 186 MDRD and −7.9 ml min −1 1.73 m −2 (p<0.05) with the 175 MDRD equation. In group 2, iGFR was 119.4±20.2 ml min −1 1.73 m −2 , and eGFR was 92.3±18.6 and 97.5±21.6 ml min −1 1.73 m −2 using the 186 and 175 MDRD equations, respectively. Method bias was −27.1 with the 186 MDRD equation and −21.9 ml min −1 1.73 m −2 (p<0.05) with the 175 MDRD equation. Conclusions/interpretation In patients newly diagnosed with type 2 diabetes, the revised 175 MDRD equation was less biased than the traditional 186 MDRD equation. Despite a continued tendency to underestimate isotopically measured GFR, use of standardised creatinine values is a positive step towards improved estimation of GFR.

Glomerular filtration rate estimation in patients with type 2 diabetes: creatinine- or cystatin C-based equations?

“…This result is not supported by some previous studies. It has been extensively demonstrated that the MDRD equation, although reasonably accurate when evaluating the kidney function of patients with chronic kidney disease [26,27], tends to underestimate the GFR in participants with normal or near-normal renal function [26,27], as well as in diabetic patients [28], especially those with obesity [29]. This systemic underestimation has been ascribed to the fact that the MDRD equation was developed in chronic kidney disease patients.…”

Population Pharmacokinetic and Exposure–Response Analysis of Finerenone: Insights Based on Phase IIb Data and Simulations to Support Dose Selection for Pivotal Trials in Type 2 Diabetes with Chronic Kidney Disease

“…Notably, two different methods were used to derive eGFR. The eGFR derived using the Modification of Diet in Renal Disease (MDRD) study equation (here termed eGFR-MDRD) is historically the more widely used biomarker [18][19][20], whereas eGFR according to the CKD Epidemiology Collaboration (CKD-EPI) equation (here termed eGFR-EPI) is calculated using a more recent formula more specific for CKD [21,22] (see also Eqs. S9 and S10 in the ESM Functional Forms).…”

The Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation is less accurate in patients with Type 2 diabetes when compared with healthy individuals

“…The National Kidney Foundation recommends the use of the Modification of Diet in Renal Disease (MDRD) study equation to estimate GFR [2]. However, it has been extensively demonstrated that this equation, although reasonably accurate to evaluate the kidney function of patients with chronic kidney disease (CKD) [3,4], tends to underestimate the GFR in subjects with normal or near‐normal renal function [5–7], as well as in diabetic patients [8,9]. This systematic underestimation has been ascribed to the fact that the MDRD equation was developed in CKD patients.…”