Kidney Disease: Improving Global Outcomes (KDIGO)

Topic:

Estimation Kidney Function

Guideline
Recommendation :

Evidence:

Notes:

CARI-Australia November 2003	- Estimation of GFR every three months from a value of 30mL/min/1.73m² and monthly from a GFR ‹ 10 mL/min/1.73 m². - A valid estimate of GFR should be used to monitor renal function. The recommended method is the mean of urea and creatinine clearances which provides a more accurate estimate of glomerular filtration than calculated creatinine clearance alone. Certain GFR equations that take into account serum creatinine and patient variables are sufficiently clinical useful. MDRD 4 variable and 6 variable and Cockrouft Gault provide reliable eGFR Clinical laboratory's should use an eGFR together with serum creatinine eGFR are generally more reliable than creatinine clearance measurements eGFR can be unreliable in certain circumstances No data that cystatin C is better than eGFR	Guidelines: Part 1-Dialysis Guidelines. Acceptance onto dialysis 3. Measurement of renal function in the chronic renal failure patient For rationale, each time read below the guidelines. 1. Use of serum creatinine concentration to assess level of kidney function 2. Use of estimated glomerular filtration rate to assess level of kidney function 3. Use of cystatin C	Level C Evidence Level B Evidence The ‘gold standard’ technique is measurement of inulin clearance. Residual renal function may also be expressed as Kt/V. Evidence level III Evidence level III Evidence level III
CSN-Canada 1999	- Measure or calculate creatinine clearance for all patients with a serum creatinine > 200µmol/L (2.3 mg/dL). - Measure creatinine clearance using a 24-h urine collection and a serum creatinine or calculate it using the Cockroft-Gault formula. - Measure renal function in patients with a creatinine clearance <30mL/min using the mean of urea and creatinine clearance (corrected to a body surface of 1.73m2). -Measure renal function at least every 3 months.	Guideline 1.1 Referral for management of renal failure P 3 of 35 PDF pages Guideline 1.2 Managing patients with a creatinine clearance <30ml/min P 3 of 35 PDF pages	Opinion. Evidence level I. Evidence level I.
EBPG-Europe 2002	- Renal function should not be measured with blood urea or creatinine alone. Cockroft and Gault or reciprocal creatinine plots should not be used when GFR <30mL/min or to determine the need for dialysis. - GFR should only be estimated using a validated method in patients with advanced renal failure. The preferred methods are the MDRD equation and the mean of urea and creatinine clearance. The latter is best calculated from a 24-h urine collection and normalized to 1.73m2. -Other validated GFR estimations are indicator decay methods (inulin and EDTA) and creatinine clearance after oral cimetidine.	Guideline I.1 Measurement of renal function	Evidence level A. Evidence level B.
KDOQI-US February 2004	- Estimates of GFR are the best overall indices of the level of kidney function. The level of GFR should be estimated from prediction equations that take into account the serum creatinine concentration and some or all of the following variables: age, gender, race, and body size. -In adults, the MDRD Study and Cockcroft-Gault equations are useful estimates. The serum creatinine concentration alone should not be used to assess the level of kidney function. - Clinical laboratories should report an estimate of GFR using a prediction equation and should use international standard methods for creatinine measurement. - Measurement of creatinine clearance using 24-h urine collections does not improve the estimate of GFR over that provided by prediction equations. A 24-hour urine sample provides useful information for estimation of GFR in individuals with exceptional dietary intake or muscle mass, assessment of diet and nutritional status, need to start dialysis.	Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification and stratification Part 5: Evaluation of laboratory measurements for clinical assessment of kidney disease. Guideline 4: Estimation of GFR	Inulin clearance is the golden standard. Among adults, the MDRD Study equation provides a clinically useful estimate of GFR (up to approximately 90 mL/min/1.73 m2) The MDRD is standardized for body surface area.
UK-Guidelines August 2002	The most valued measure of renal function is the GFR which can only be measured using complex clearance studies (eg inulin).	Chapter 2: Epidemiology of chronic renal failure and renal replacement therapy P 44 of 204 PDF pages	Not a guideline
KDIGO June 2005	- Estimating equations for GFR should: Have been developed in large cohorts, including a variety of ethnic and racial groups Have been evaluated in an independent cohort Have been validated to have adequate precision and low bias against gold standard GFR Be practical to implement - Abbreviated MDRD formula meets most of these criteria - Cockroft-Gault more difficult to implement in clinical laboratories - Both MDRD and Cockroft-Gault are imprecise at high GFR values	In: Definition of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International, 67, 2089-2100, 2005	Position statement emanating from Controversies Conference (Amsterdam, the Netherlands, November 16-17, 2004)