Measured and estimated glomerular filtration rate: current status and future directions

@article{Levey2019MeasuredAE,  title={Measured and estimated glomerular filtration rate: current status and future directions},  author={Andrew S. Levey and Josef Coresh and Hocine Tighiouart and Tom Greene and Lesley A. Inker},  journal={Nature Reviews Nephrology},  year={2019},  volume={16},  pages={51-64},  url={https://api.semanticscholar.org/CorpusID:202573933}}
The authors of this Perspectives article describe the physiological and statistical principles underlying measured glomerular filtration rate (mGFR) and estimated GFR (eGFR), and discuss their limitations, the circumstances under which mGFR and eGFR should be used, and approaches to improve these methodologies.

247 Citations

Measurement and Estimation of GFR for Use in Clinical Practice: Core Curriculum 2021.

Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research and methods for optimal assessment in routine practice or special circumstances, and their strengths and limitations are critical in making judicious use of the available tools.

Improving Glomerular Filtration Rate Estimation—Across the Age and Diversity Spectrum

The EKFC equation was unbiased across all age groups (median bias near zero), and P30 accuracy (percentage of eGFR within 30% of mGFR) was approximately 80% in children (aged 2 to 18 years) and ranged from 85% to 90% in adults (>18 years) but not in middle-aged adults (40 to <65 years).

Traditions and innovations in assessment of glomerular filtration rate using creatinine to cystatin C.

Current methods of estimating GFR have improved in population measures of reliability, but all have significant individual-level inaccuracies that can be an issue when clinical decision-making is contingent on the actual level of GFR.

Panel estimated Glomerular Filtration Rate (GFR): Statistical considerations for maximizing accuracy in diverse clinical populations

Methods for estimating GFR based on multiple markers in applications with potentially higher rates of outlying predictors than in development data are proposed and transfer learning is applied to address systematic differences between application and development populations.

Assessment of kidney function: clinical indications for measured GFR

Clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C–based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinines-based GFR estimation may be invalid are highlighted.

Kidney function estimation equations: a narrative review

Among the many available equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most recommended due to its robustness and accuracy across diverse patient populations.

Prospects for improved glomerular filtration rate estimation based on creatinine—results from a transnational multicentre study

Prospects for improved GFR estimation procedures based on creatinine exist, particularly in young adults and in settings where patients with suspected or manifest CKD are investigated.

Update on the Assessment of GFR in Patients with Cancer

Advances in GFR evaluation in patients with cancer considering the new Kidney Disease Improving Global Outcomes guidelines and other recent data are summarized.

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Glomerular filtration rate (GFR) is considered the best overall measurement of kidney function and is an important clinical variable used in determining the optimal management of a patient with…
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110 References

Evaluating the performance of equations for estimating glomerular filtration rate.

Methods for the evaluation of GFR estimating equations are discussed and topics addressed include statistical methods used in development and validation of equations; explanation of measures of performance used for evaluation, with focus on distinction between bias, precision and accuracy.

Estimated Glomerular Filtration Rate From a Panel of Filtration Markers-Hope for Increased Accuracy Beyond Measured Glomerular Filtration Rate?

It is hypothesized, and begun to test the hypothesis, that a panel of filtration markers (panel eGFR) from a single blood draw would require fewer demographic or clinical variables and could estimate GFR as accurately as measured GFR.

Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective.

The assessment of kidney function is a cornerstone in the clinical management and health of the patient. Although the kidneys perform many physiologic functions and are essential for maintaining…

Measured GFR in Routine Clinical Practice-The Promise of Dried Blood Spots.

Examination of the current literature and data addressing GFR measurements by dried capillary blood spots and its potential application in high-risk groups finds it to be of concern in populations at high risk for kidney disease.

GFR estimation: from physiology to public health.

The CKD-EPI (CKD Epidemiology Collaboration) equations are the most accurate GFR estimating equations that have been evaluated in large diverse populations and are applicable for general clinical use.

Accuracy of a GFR estimating equation over time in people with a wide range of kidney function.

The accuracy of GFR estimates did not change over time, and Clinicians should interpret changes in estimated GFR over time as reflecting changes in measured GFR rather than changes in errors in the GFR Estimates in most individuals.

Estimating Equations for Glomerular Filtration Rate in the Era of Creatinine Standardization

The performance of GFR estimating equations is reviewed to inform the selection of a single equation by laboratories and the interpretation of estimated GFR by clinicians, and neither the CKD-EPI nor the MDRD Study equation is optimal for all populations and GFR ranges.

Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review.

The performance of GFR estimating equations is reviewed to inform the selection of a single equation by laboratories and the interpretation of estimated GFR by clinicians and neither the CKD-EPI nor the MDRD Study equation is optimal for all populations and GFR ranges.

A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation

The purpose of this study was to develop an equation from MDRD Study data that could improve the prediction of GFR from serum creatinine concentration, and major clinical decisions in general medicine, geriatrics, and oncology are made by using the Cockcroft-Gault formula and other formulas to predict the level of renal function.
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