Andrew D. Rule, MD; Fernando G. Cosio, MD
Potential Financial Conflicts of Interest: None disclosed.
Rule AD, Cosio FG. The New Mayo Clinic Equation for Estimating Glomerular Filtration Rate. Ann Intern Med. 2005;142:681. doi: 10.7326/0003-4819-142-8-200504190-00031
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Published: Ann Intern Med. 2005;142(8):681.
We are gratified that our article has generated a healthy discussion. It was not our intent to initiate a debate about “whose GFR equation is best.” All of the available equations, including ours, have limitations. Instead, we believe we should concentrate our efforts on whether a generalizable equation based on serum creatinine can be developed (this may not be possible). We also believe that it is important to be cautious when interpreting the prevalence of a reduced estimated GFR in various populations.
The discrepancy between our results and those of Froissart and colleagues may be related to differences in methods. In our study, we compared patients with chronic kidney disease who had an estimated (not measured) GFR greater than 60 mL/min per 1.73 m2 with healthy persons. Since the objective was to compare the accuracy of equations in predicting measured GFR, we did not identify or stratify the chronic kidney disease and healthy samples by measured GFR. The quadratic GFR equation (derived by using two-thirds healthy persons and one-third patients with chronic kidney disease) should be tested in populations where the diagnosis of chronic kidney disease is unknown, such as the general population. Even with careful attention to creatinine assay calibration, other investigators showed that at a GFR of 60 mL/min per 1.73 m2, the MDRD equation underestimated measured GFR by 30 mL/min per 1.73 m2 among healthy persons (1).
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