MDRD4 Equation Is Better Than CKD-EPI, Cockroft-Gault and Nankivell Equations to Estimate Glomerular Filtration Rate in Renal Transplantation

E. David-Neto,¹ A. Triboni,¹ F. Ramos,¹ F. Agena,¹ F. Lemos,¹ M. Sapienza,² W. Nahas.¹

¹Renal Transplantation Service, Hospital das Clínicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil
²Nuclear Medicine Institute, Hospital das Clínicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

Meeting: 2015 American Transplant Congress

Abstract number: B103

Keywords: Glomerular filtration rate (GFR), Kidney transplantation

Session Information

Session Name: Poster Session B: Kidney Complications: Late Graft Failure

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

To evaluate which estimated GFR (eGFR) equation is the most appropriate to in kidney transplanted (KTx) recipients, we obtained data from all plasma EDTA-Cr51 clearances (n=552) performed in 328 transplanted patients from 01/Jan/2008 to 31/Sep/2014 and compared the results with the Cockroft-Gault (C-G), Modification of Diet in Renal Disease (MDRD4), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Nankivell equations calculated using parameters obtained ±10 days from each EDTA-Cr51 measurement. Plasma EDTA-Cr51 has been validated against the Inulin urinary clearance. 328 patients (F=150/M=178) with a mean age of 43±8y (15-78), (white=215/ non-white=113) using kidneys from deceased (n=186) and live (n=142) donors had EDTA-Cr51 measured at a median of 222 days (95%C.I.: 90-620) after transplantation with CKD stages 1-2 (n=183), 3 (n=306) and 4-5 (n=63). Spearman Correlation coefficient (R²) and Bland&Altman analysis were performed. Mean value for EDTA-Cr51 (51±19 ml/min) was significantly different from Nankivell (63±20, p<0.001), C-G (56±19, p<0.001), CKD-EPI (55±22, p=0.035) but not from MDRD4 (53±19ml/min, p=0.328). R² was statistically significant (p<0.001) for all equations but higher for CKD-EPI and MDRD4 (Nankivell:0,56; C-G:0.53; MDRD4:0.63; CKD-EPI:0.64). In the B&A analysis the mean difference between EDTA-Cr51 and the equations was lower for the MDRD4 (1.5±12.5ml/min, which also differed significantly (p<0.001) from the mean differences in the other equations) than any of the others (CKD-EPI: 3.4±13.1; C-G:4.9±14.1; Nankivell: 11.3±14.2 ml/min). B&A graphics visualization show that the agreement between EDTA-Cr51 and MDRD4 was better that any other equations particularly in the eGFR between 20-60 ml/min, an usual GFR range for transplanted kidneys. These data show that the MDRD4 equation continues to be the best eGFR equation to use in clinical practice and research, with lower differences between estimated and measured GFR and, therefore, a better agreement.

To cite this abstract in AMA style:

David-Neto E, Triboni A, Ramos F, Agena F, Lemos F, Sapienza M, Nahas W. MDRD4 Equation Is Better Than CKD-EPI, Cockroft-Gault and Nankivell Equations to Estimate Glomerular Filtration Rate in Renal Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/mdrd4-equation-is-better-than-ckd-epi-cockroft-gault-and-nankivell-equations-to-estimate-glomerular-filtration-rate-in-renal-transplantation/. Accessed July 3, 2025.

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