Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft–Gault equation in screening for impaired kidney function in Japanese Americans

Gerchman, Fernando; Tong, Jenny; Utzschneider, Kristina M.; Hull, Rebecca L.; Zraika, Sakeneh; Udayasankar, Jayalakshmi; McNeely, Marguerite J.; Andress, Dennis L.; Leonetti, Donna L.; Boyko, Edward J.; Fujimoto, Wilfred Y.; Kahn, Steven E.

doi:10.1016/j.diabres.2006.11.001

« Previous Next »Diabetes Research and Clinical Practice
Volume 77, Issue 2 , Pages 320-326, August 2007

Superiority of the Modification of Diet in Renal Disease equation over the Cockcroft–Gault equation in screening for impaired kidney function in Japanese Americans

Fernando Gerchman
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Jenny Tong
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Kristina M. Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Rebecca L. Hull
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Sakeneh Zraika
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Jayalakshmi Udayasankar
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Marguerite J. McNeely
- Division of General Internal Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Dennis L. Andress
- Division of Nephrology, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Donna L. Leonetti
- Department of Anthropology, University of Washington, Seattle, WA, USA
Edward J. Boyko
- Division of General Internal Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
- Epidemiology Research Information Center, VA Puget Sound Health Care System, Seattle WA, USA
Wilfred Y. Fujimoto
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
- Corresponding author at: VA Puget Sound Health Care System and University of Washington (151), 1660 S. Columbian Way, Seattle, WA 98108, USA. Tel.: +1 206 764 2148; fax: +1 206 277 3011.

Received 31 October 2006; accepted 6 November 2006. published online 06 December 2006.

Abstract

The Cockcroft–Gault and the Modification of Diet in Renal Disease (MDRD) Study equations have not been validated in Asian Americans with varying degrees of glucose tolerance. We compared both equations to 24-h urinary creatinine clearance, the latter as a standard measurement of glomerular filtration rate (GFR), in 398 Japanese Americans (62.1±5.8 years, mean±S.D.) who had normal glucose tolerance (NGT) (n=138), impaired glucose tolerance (IGT) (n=136) and diabetes (n=124). Although both the Cockcroft–Gault (r=0.65, P<0.001) and the MDRD (r=0.74, P<0.001) equations correlated well with creatinine clearance, the latter was significantly superior (P=0.013 between r values). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the MDRD equation was significantly greater than for the Cockcroft–Gault equation (AUC 0.86 versus 0.80, P=0.015) in classifying subjects as having mildly reduced GFR (<90ml/min per 1.73m²). However, both equations overestimated the number of individuals with decreased GFR. We conclude therefore that while the MDRD equation more accurately identifies Asians who are in the early stages of kidney disease, as for other groups, a correction term appears necessary in order to reduce the number of Asian subjects being falsely diagnosed with CKD.