Recruitment experience in the full-scale phase of the modification of diet in renal disease study

Kusek, John W.; Coyne, Terry; Velasco, Ann de; Drabik, Martin; Finlay, Robert; Gassman, Jennifer; Kiefer, Sally; Powers, Sandra; Steinman, Theodore I.

doi:10.1016/0197-2456(93)90033-a

Cited by 43 publications

(12 citation statements)

References 14 publications

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“…Considering the success of the MDRD, the main goal of the present review was to determine whether the CG formula should be abandoned or if it still has a place in renal function analysis. In the original MDRD study, several subgroups were excluded or insufficiently represented, including the elderly, diabetics, patients with end-stage renal disease or renal disease with normal SCr levels, over- or underweight patients, dialysis patients, kidney transplant recipients, patients receiving immunosuppressive or corticosteroid treatment, frequently hospitalized patients, or patients with other serious medical conditions [9,10,11]. Additional studies have been performed to validate the MDRD in these subgroups.…”

Section: Introductionmentioning

confidence: 99%

Should We Continue to Use the Cockcroft-Gault Formula?

Hélou¹

2010

Nephron Clin Pract

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Background/Aims: Although the National Kidney Disease Education Program recommends use of the modification of diet in renal disease (MDRD) formula to estimate the glomerular filtration rate (GFR), most drug-dosing recommendations and clinical practices employ the Cockcroft-Gault (CG) formula. The quality score of the original MDRD study was better than that of the original CG study, although the imprecision sources were very similar between the formulas. To address whether CG should be abandoned in favour of MDRD in chronic kidney disease (CKD) management, we performed a literature review on the topic. Methods: We reviewed 27 articles comparing CG and MDRD in terms of bias, precision, accuracy, and the risk of misclassifying by two CKD stages. Results: In the chronic renal disease population, MDRD was more precise, safer and more accurate than CG at predicting the GFR, with two exceptions: CG was clearly superior in CKD patients with a normal serum creatinine (SCr) and results were discordant in patients with advanced renal failure. In diabetic populations with normal and near-normal GFR, the decline in renal function in diabetics was better screened by CG. In diabetics with renal impairment, MDRD is more accurate than CG. In healthy patients, in subjects with normal SCr and in elderly patients, MDRD was not superior. Based on the risk of misclassifying by ≧2 CKD stages, neither formula could be safely applied in diabetic, low body mass index, advanced liver disease, chronic heart failure, or hospitalized patients. Conclusions: CG still has an interest in screening the decline in renal function in subjects with normal SCr who are at risk, such as diabetics and stage 1 and 2 CKD patients, as well as healthy subjects enrolled in clinical trials and pharmacokinetic studies. Thus, it may be early to replace CG by MDRD in drug studies. CG still is the better formula in the elderly. Both formulas are not safe in some populations.

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Section: Introductionmentioning

confidence: 99%

Should We Continue to Use the Cockcroft-Gault Formula?

Hélou¹

2010

Nephron Clin Pract

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“…Compared with patients with CKD, GFR estimates may have greater inaccuracy in general populations 35. The MDRD equation was developed from the US population36 37; nevertheless, currently there is no correction of the MDRD equation based on Taiwanese ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Association of blood lead and mercury with estimated GFR in herbalists after the ban of herbs containing aristolochic acids in Taiwan

et al. 2013

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We found that lower estimated GFR was associated with blood lead and mercury in herbalists after the ban of herbs containing ALAs in Taiwan. The ALA-I exposure did not show a significant negative association of estimated GFR, which might due to herbalists having known how to distinguish ALA herbs after the banning policy. Rigorous monitoring is still needed to protect herbalists and the general population who take herbs.

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“…Details of the screening and enrollment procedures have been published previously. 15–17 Briefly, entry criteria for the screening phase included age between 18 and 70 years, serum creatinine of 1.2 to 7.0 mg/dL in women, 1.4 to 7.0 mg/dL in men, or creatinine clearance less than 70 mL/min/1.73 m 2 . Exclusion criteria included pregnancy, type 1 diabetes, insulin-dependent type 2 diabetes, glomerulonephritis due to autoimmune diseases such as systemic lupus erythematosus, obstructive uropathy, renal artery stenosis, proteinuria greater than 10 g/d, mean arterial pressure greater than 125 mm Hg, and prior kidney transplantation.…”

Section: Methodsmentioning

confidence: 99%

The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis

Viswanathan¹,

Sarnak²,

Tighiouart³

et al. 2013

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Background: Albuminuria is strongly associated with future risk for cardiovascular and kidney outcomes, and has been proposed to be included in the classification of chronic kidney disease (CKD) along with glomerular filtration rate (GFR). Few data are available on whether albuminuria is associated with concurrent complications of CKD. Methods: A cross-sectional analysis of 1,665 participants screened for the Modification of Diet in Renal Disease (MDRD) study was performed to examine the association between albuminuria (determined using urine albumin-creatinine ratio (ACR)) and measured GFR (determined using urinary clearance of iothalamate) with anemia, acidosis, hyperphosphatemia, and hypertension. Results: Mean GFR (± SD) was 39 ml/min/1.73 m2 (± 21) and the median (25 – 75th percentile) ACR was 161 (38 – 680) mg/g. In multivariable models adjusted for age, sex, race, kidney disease etiology, and GFR, higher ACR levels were not associated with any complication. For example, comparing ACR > 300 mg/g vs. < 30 mg/g, the prevalence ratio (95% CI) for anemia was 0.98 (0.81 – 1.20), acidosis 1.13 (0.86 – 1.48), hyperphosphatemia 1.69 (0.91 – 3.17), and hypertension 1.04 (0.97 – 1.12). Lower levels of GFR were associated with all complications. For example, GFR levels < 30 ml/min/1.73 m2 vs. GFR levels 60 – 89 ml/min/1.73 m2 were associated with prevalence ratios (95% CI) of anemia 4.35 (3.18 – 5.96), acidosis 5.31 (3.41 – 8.29), hyperphosphatemia 23.8 (7.71 – 73.6), and hypertension 1.21 (1.10 – 1.32). Conclusions: Albuminuria is not associated with complications after controlling for GFR in patients younger than 70 years of age with non-diabetic CKD and GFR less than 90 ml/min/1.73 m2 and thus would not affect clinical action plans for decisions regarding evaluation and treatment of complications in similar populations.

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Recruitment experience in the full-scale phase of the modification of diet in renal disease study

Cited by 43 publications

References 14 publications

Should We Continue to Use the Cockcroft-Gault Formula?

Should We Continue to Use the Cockcroft-Gault Formula?

Association of blood lead and mercury with estimated GFR in herbalists after the ban of herbs containing aristolochic acids in Taiwan

The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis

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