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

  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},
Evaluation of glomerular filtration rate (GFR) is central to the assessment of kidney function in medical practice, research and public health. Measured GFR (mGFR) remains the reference standard, but the past 20 years have seen major advances in estimated GFR (eGFR). Both eGFR and mGFR are associated with error compared with true GFR. eGFR is now recommended by clinical practice guidelines, regulatory agencies and public health agencies for the initial evaluation of GFR, with measured GFR (mGFR… 
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.
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.
Should Estimated Glomerular Filtration Rate Be Adjusted for Race?
  • B. Cohen
  • Medicine
    Clinical pharmacology in drug development
  • 2021
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
Clinical Implications of the New Equation to Estimate Glomerular Filtration Rate
A significant proportion of patients will be reclassified downward by the EKFC compared to the CKD-EPI equation with a particular reference between CKD stages 1-2 and 2-3 and age categories of 18-30 and ≥61 years, respectively.
Comparison of Cystatin C and Creatinine-Based Equations with Measured Glomerular Filtration Rate in a Diverse Pediatric Population.
Overall, CysC-based equations without race correction provide a good approximation of mGFR and a less invasive alternative to monitoring kidney function in pediatric population, irrespective of race/ethnicity.
Improved equations to estimate GFR in Chinese children with chronic kidney disease
New equations for GFR estimation in Chinese children with CKD based on Scr, BUN and cystatin C are developed, which are more accurate than commonly used equations in this population.
Perspective on New Equations for Estimating Glomerular Filtration Rate.
Calculated estimated glomerular filtration rate (eGFR) is recommended using equations developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for adults ≥18 years and by the CKiD in Children for ages <18”years because they used readily available information.


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.
  • A. Levey, L. Inker, J. Coresh
  • Medicine, Biology
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2014
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.