Predictive performance of 12 equations for estimating glomerular filtration rate in severely obese patients

Serpa Neto, Ary; Rossi, Felipe Martin Bianco; Amarante, Rodrigo Dal Moro; Rossi, Marçal

doi:10.1590/S1679-45082011AO1922

Ary Serpa NetoCorresponding author: Ary Serpa Neto – Avenida Lauro Gomes, 2000 – Sacadura Cabral – CEP 09060-6300 – Santo André (SP), Brasil – Tel.: 11 4993-5400 – E-mail: aryserpa@terra.com.br

Faculdade de Medicina do ABC - FMABC, Santo André (SP), Brazil

Felipe Martin Bianco Rossi

Faculdade de Medicina do ABC - FMABC, Santo André (SP), Brazil

Rodrigo Dal Moro Amarante

Faculdade de Medicina do ABC - FMABC, Santo André (SP), Brazil

Marçal Rossi

Faculdade de Medicina do ABC - FMABC, Santo André (SP), Brazil

Corresponding author: Ary Serpa Neto – Avenida Lauro Gomes, 2000 – Sacadura Cabral – CEP 09060-6300 – Santo André (SP), Brasil – Tel.: 11 4993-5400 – E-mail: aryserpa@terra.com.br

Conflict of interest: none

Gold Standard
GFR = Ucr x V / Pcr x 1440	FFM = Wt – FM
	Equations evaluated
Jackson, Pollock(²⁴24. Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr. 1978;40(3):497-504.)	FM = Wt x [(1.61 x BMI) + (0.13 x Age) – (12.1 x Gender) – 13.9] / 100 (Female = 0; Male = 1)
Jackson et al.(²⁵25. Jackson AS, Pollock ML, Ward A. Generalized equations for predicting body density of women. Med Sci Sports Exerc. 1980;12(3):175-81.)
Sobh et al.(¹⁵15. Sobh M, Neamatallah A, Sheashaa H, Akl A, Osman Y, Gad H, et al. Sobh formula: a new formula for estimation of creatinine clearance in healthy subjects and patients with chronic renal disease. Int Urol Nephrol. 2005;37(2):403-8.)	Cl_cr = [(140 – Age) / Pcr] x Wt^0.54 x Ht^0.40 x 0.014
	Cl_cr (men) = [(100 / Pcr) – 12] x (BSA / 1.73)
Jelliffe (¹⁷17. Jelliffe RW. Estimation of creatinine clearance when urine cannot be collected. Lancet. 1971;1(7706):975-6.)	Cl_cr (women) =[(80 / Pcr) – 7] x (BSA / 1.73)
Jelliffe (¹⁸18. Jelliffe RW. Letter: Creatinine clearance: bedside estimate. Ann Intern Med. 1973;79(4):604-5.)	Cl_cr = [98 – 0.8(Age – 20) / Pcr] x (BSA / 1.73) (x 0.9 if women)
	Cl_cr (men) = Wt[29.3 – (0.203 x Age)] x [1 – (0.03 x Pcr)] / (14.4 x Pcr) x (70 / Wt)
Mawer et al.(¹⁹19. Mawer GE, Lucas SB, Knowles BR, Stirland RM. Computer-assisted prescribing of kanamycin for patients with renal insufficiency. Lancet. 1972;1(7740):12-5.)	Cl_cr (women) = Wt[25.3 – (0.175 x Age)] x [1 – (0.03 x Pcr)] / (14.4 x Pcr) x (70 / Wt)
Gates(²⁰20. Gates G F. Creatinine clearance estimation from serum creatinine values: an analysis of three mathematical models of glomerular function. Am J Kidney Dis. 1985;5(3):199-205.)	Cl_cr (men) = (89.4 x Pcr^−1.2) + (55 – Age) x (0.447 x Pcr^−1.1) x (BSA / 1.73)
	Cl_cr (women) = (60 x Pcr^−1.1) + (56 – Age) x (0.3 x Pcr^−1.1) x (BSA / 1.73)
Bjornsson(²²22. Bjornsson TD. Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet. 1979;4(3):200-22.)	Cl_cr (men) = [27 – (0.173 – Age)] x (Wt x 0.07) / Pcr
	Cl_cr (women) = [25 – (0.175 – Age)] x (Wt x 0.07) / Pcr
Davis, Chandler(²³23. Davis GA, Chandler MH. Comparison of creatinine clearance estimation methods in patients with trauma. Am J Health Syst Pharm. 1996;53(9):1028-32.)	Cl_cr = (140 – Age) / Pcr (x 0.85 if women)
Hull et al.(²¹21. Hull JH, Hak LJ, Koch GG, Wargin WA, Chi SL, Mattocks AM. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther. 1981;29(4):516-21.)	Cl_cr = [((145 – Age) / Pcr) – 3] x (Wt / 70) (x 0.85 if women)
MDRD complete(¹⁴14. Levey AS, Bosch J P, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70.)	Cl_cr = 170 x Pcr^−0.999 x Age^−0.176 x BUN^−0.170 x Albumin^0.318 (x 0.762 if women)
Cockcroft, Gault(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	Cl_cr = (140 – Age) x Wt / 72 x Pcr (x 0.85 if women)
CG-FFM(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	Cl_cr = (140 – Age) x FFM / 72 x Pcr (x 0.85 if women)
Salazar, Corcoran(¹³13. Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84(6):1053-60.) (Ht in meters)	Cl_cr (men) = [137 – Age] x [(0.285 x Wt) + (12.1 x Ht²)] / Pcr x 51
	Cl_cr (women) = [146 – Age] x [(0.287 x Wt) + (9.74 x Ht²)] / Pcr x 60

	ALL (n = 140) Mean (95%CI)	IGT (n = 43) Mean (95%CI)	DM (n = 24) Mean (95%CI)	MS (n = 76) Mean (95%CI)	HYP (n = 66) Mean (95%CI)
MDRD(¹⁴14. Levey AS, Bosch J P, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70.)	-28.83 (-33.27, −24.39)	-52.14 (-56.13, −48.16)	-37.63 (-46.85, −28.40)	-48.17 (-51.26, −45.09)	-32.17 (-39.13, −25.22)
Cockcroft, Gault(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	33.52 (26.89, 40.15)	22.62 (15.97, 29.28)	25.33 (7.67, 42.99)	12.31 (5.99, 18.64)	33.72 (23.15, 44.30)
Sobh et al.(¹⁵15. Sobh M, Neamatallah A, Sheashaa H, Akl A, Osman Y, Gad H, et al. Sobh formula: a new formula for estimation of creatinine clearance in healthy subjects and patients with chronic renal disease. Int Urol Nephrol. 2005;37(2):403-8.)	6.20 (-0.30, 12.70)^a a 0.00 included in 95% CI (Unbiased).	-30.35 (-37.92, −22.79)	-5.37 (-22.00, 11.24)^a a 0.00 included in 95% CI (Unbiased).	-13.13 (-21.20, −5.07)	-3.55 (-12.55, 5.45)^a a 0.00 included in 95% CI (Unbiased).
Salazar, Corcoran(¹³13. Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84(6):1053-60.)	-5.21 (-11.44, 1.02)^a a 0.00 included in 95% CI (Unbiased).	-40.46 (-48.10, −32.33)	-16.23 (-31.73, −0.72)	-24.18 (-31.87, −16.50)	-13.93 (-22.70, −5.16)
Jelliffe(¹⁷17. Jelliffe RW. Estimation of creatinine clearance when urine cannot be collected. Lancet. 1971;1(7706):975-6.)	-12,37 (-18.06, −6.68)	-45.57 (-51.98, −39.16)	-17.88 (-34.47, −1.30)	-31.41 (-37.93, −24.89)	-17.57 (-25.88, −9.26)
Jelliffe(¹⁸18. Jelliffe RW. Letter: Creatinine clearance: bedside estimate. Ann Intern Med. 1973;79(4):604-5.)	-12,27 (-18.07, −6.48)	-47.05 (-53.41, −40.69)	-22.38 (-37.19, −7.57)	-31.43 (-38.27, −24.54)	-20.82 (-28.94, −12.71)
Mawer et al.(¹⁹19. Mawer GE, Lucas SB, Knowles BR, Stirland RM. Computer-assisted prescribing of kanamycin for patients with renal insufficiency. Lancet. 1972;1(7740):12-5.)	109.68 (95.57, 123.80)	62.27 (39.86, 84.69)	95.06 (62.86, 127.25)	88.42 (69.09, 107.75)	95.23 (76.60, 113.86)
Gates(²⁰20. Gates G F. Creatinine clearance estimation from serum creatinine values: an analysis of three mathematical models of glomerular function. Am J Kidney Dis. 1985;5(3):199-205.)	-53.81 (-59.96, −47.66)	-87.18 (-94.11, −80.25)	-60.15 (-77.15, −43.15)	-72.50 (-80.31, −64.69)	-60.65 (-69.48, −51.82)
Hull et al.(²¹21. Hull JH, Hak LJ, Koch GG, Wargin WA, Chi SL, Mattocks AM. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther. 1981;29(4):516-21.)	31.47 (23.57, 39.37)	0.47 (-10.96, 11.91)^a a 0.00 included in 95% CI (Unbiased).	19.10 (0.26, 38.46)	10.44 (0.88, 20.01)	24.56 (13.98, 35.14)
Bjornsson(²²22. Bjornsson TD. Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet. 1979;4(3):200-22.)	27.41 (20.03, 34.80)	-11.60 (-20.58, −2.62)	15.42 (3.10, 33.96)	7.64 (-1.70, 16.98)^a a 0.00 included in 95% CI (Unbiased).	16.95 (7.08, 26.82)
Davis, Chandler(²³23. Davis GA, Chandler MH. Comparison of creatinine clearance estimation methods in patients with trauma. Am J Health Syst Pharm. 1996;53(9):1028-32.)	-21.65 (-27.06, −16.24)	-55.16 (-60.53, −49.78)	-31.28 (-45.84, −16.72)	-40.38 (-46.66, −34.10)	-29.74 (-37.58, −21.90)
CG FFM(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	-45.87 (-51.26, −40.47)	-76.07 (-83.67, −68.47)	-55.33 (-67.88, −42.78)	-64.67 (-71.11, −58.22)	-54.71 (-62.71, −46.71)

	ALL (n = 140) Mean (95%CI) (r)	IGT (n = 43) Mean (95%CI) (r)	DM (n = 24) Mean (95%CI) (r)	MS (n = 76) Mean (95%CI) (r)	HYP (n = 66) Mean (95%CI) (r)
MDRD(¹⁴14. Levey AS, Bosch J P, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70.)	33.40 (-29.98, −36.83) (0.06)^a a p < 0.05.	52.19 (48.27, 56.11) (0.48)^a a p < 0.05.	39.49 (31.85, 47.13) (0.23)	48.37 (45.46, 51.28) (0.52)^a a p < 0.05.	37.27 (32.10, 42.43) (0.05)
Cockcroft, Gault(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	40.95 (35.62, 46.27) (0.05)^a a p < 0.05.	27.87 (23.57, 32.18) (0.44)^a a p < 0.05.	37.34 (24.23, 50.45) (0.05)	25.64 (22.01, 29.28) (0.56)^a a p < 0.05.	40.69 (31.75, 49.63) (0.03)
Sobh et al. (¹⁵15. Sobh M, Neamatallah A, Sheashaa H, Akl A, Osman Y, Gad H, et al. Sobh formula: a new formula for estimation of creatinine clearance in healthy subjects and patients with chronic renal disease. Int Urol Nephrol. 2005;37(2):403-8.)	31.04 (27.00, 35.08) (0.25)^a a p < 0.05.	33.08 (26.72, 39.44) (0.23)	32.64 (23.50, 41.78) (0.35)	29.57 (24.29, 34.85) (0.39)^a a p < 0.05.	29.13 (23.67, 34.59) (0.18)
Salazar, Corcoran(¹³13. Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84(6):1053-60.)	30.31 (26.61, 34.02) (0.26)^a a p < 0.05.	42.21 (35.56, 48.86) (0.33)^a a p < 0.05.	33.02 (23.71, 42.33) (0.35)	34.41 (29.18, 39.64) (0.42)^a a p < 0.05.	31.72 (26.52, 36.92) (0.18)
Jelliffe(¹⁷17. Jelliffe RW. Estimation of creatinine clearance when urine cannot be collected. Lancet. 1971;1(7706):975-6.)	29.12 (25.54, 32.70) (0.22)^a a p < 0.05.	45.57 (39.16, 51.98) (0.08)	35.24 (25.06, 45.41) (0.44)^a a p < 0.05.	36.14 (31.08, 41.20) (0.32)^a a p < 0.05.	30.83 (25.38, 36.27) (0.15)
Jelliffe 1973(¹⁸18. Jelliffe RW. Letter: Creatinine clearance: bedside estimate. Ann Intern Med. 1973;79(4):604-5.)	29.77 (26.18, 33.36) (0.24)^a a p < 0.05.	47.38 (41.27, 53.50) (0.13)	34.25 (24.54, 43.96) (0.34)	37.03 (31.88, 42.18) (0.35)^a a p < 0.05.	32.42 (27.14, 37.70) (0.15)
Mawer et al. (¹⁹19. Mawer GE, Lucas SB, Knowles BR, Stirland RM. Computer-assisted prescribing of kanamycin for patients with renal insufficiency. Lancet. 1972;1(7740):12-5.)	111.45 (97.73, 125.17) (0.26)^a a p < 0.05.	68.01 (47.28, 88.75) (0.43)^a a p < 0.05.	100.02 (70.75, 129.29) (0.33)	91.67 (73.15, 110.18) (0.45)^a a p < 0.05.	97.46 (79.55, 115.37) (0.17)
Gates(²⁰20. Gates G F. Creatinine clearance estimation from serum creatinine values: an analysis of three mathematical models of glomerular function. Am J Kidney Dis. 1985;5(3):199-205.)	58.01 (53.05, 62.97) (0.24)^a a p < 0.05.	87.18 (80.25, 94.11) (0.46)^a a p < 0.05.	66.40 (54.49, 78.31) (0.42)^a a p < 0.05.	76.05 (70.30, 81.80) (0.42)^a a p < 0.05.	64.12 (56.95, 71.29) (0.27)^a a p < 0.05.
Hull et al.(²¹21. Hull JH, Hak LJ, Koch GG, Wargin WA, Chi SL, Mattocks AM. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther. 1981;29(4):516-21.)	43.77 (37.73, 49.80) (0.13)^a a p < 0.05.	30.73 (24.46, 36.99) (0.01)	35.64 (21.27, 50.01) (0.55)^a a p < 0.05.	32.33 (25.86, 38.80) (0.09)	38.00 (30.23, 45.77) (0.03)
Bjornsson(²²22. Bjornsson TD. Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet. 1979;4(3):200-22.)	39.92 (34.36, 45.47) (0.25)^a a p < 0.05.	25.30 (19.68, 30.92) (0.22)	36.87 (25.26, 48.48) (0.38)	29.89 (23.32, 36.45) (0.39)^a a p < 0.05.	32.14 (24.95, 39.32) (0.16)
Davis, Chandler(²³23. Davis GA, Chandler MH. Comparison of creatinine clearance estimation methods in patients with trauma. Am J Health Syst Pharm. 1996;53(9):1028-32.)	32.06 (28.38, 35.74) (0.18)^a a p < 0.05.	55.16 (49.78, 60.53) (0.06)	40.70 (31.56, 49.98) (0.31)	44.28 (39.60, 48.97) (0.27)^a a p < 0.05.	36.84 (31.13, 42.54) (0.14)
CG FFM(¹²12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.)	48.00 (43.15, 52.85) (0.28)^a a p < 0.05.	76.07 (68.47, 83.67) (0.56)^a a p < 0.05.	56.07 (44.14, 68.00) (0.22)	65.72 (59.87, 71.58) (0.45)^a a p < 0.05.	55.62 (48.02, 63.22) (0.27)^a a p < 0.05.

[1] Corresponding author: Ary Serpa Neto – Avenida Lauro Gomes, 2000 – Sacadura Cabral – CEP 09060-6300 – Santo André (SP), Brasil – Tel.: 11 4993-5400 – E-mail: aryserpa@terra.com.br

Brasil

Brasil

Predictive performance of 12 equations for estimating glomerular filtration rate in severely obese patients

ABSTRACT

Objective:

Methods:

Results:

Conclusion: