MDRD GFR Equation
For CKD patients (not for AKI).
id
76
full_title
MDRD GFR Equation
short_title
MDRD GFR Equation
med_description
Estimates GFR in CKD patients using creatinine and patient characteristics.
description
The MDRD GFR Equation estimates glomerular filtration rate based on creatinine and patient characteristics.
keywords
MDRD GFR equation, mdrd, mdrd crcl, mdrd gfr, mdrd glomerular, mdrd filtration, mdrd equation, mdrd calc, mdrd score, mdrd gfr calc, mdrd equation, gfr equation, gfr estimate, gfr creatinine, gfr cr, gfr creatinine estimate, gfr mdrd estimate, mdrd glomerular filtration rate, mdrd glom, mdrd glom fil, gfr by age, gfr by race, gfr labs, gfr calcs, gfr score, gfr creatinine, mdrd creatinine, glomerular filtration, glomerular rate, gfr equation, gfr rate, mdrd rate, levey gfr, levey mdrd, levey equation, levey kidney equation, renal gfr, renal calc gfr, renal calculator mdrd, renal calculator gfr, renal calc mdrd
complaint
[ "AMS", "Dyspnea", "Extremity Edema", "Headache" ]
formula
GFR = 175 × Serum Cr-1.154× age-0.203× 1.212 (if patient is black*) × 0.742 (if female) Use serum Cr in mg/dL for this formula. FromLevey 2006. Note: the original MDRD study equation used a constant of 186, which the authors later revised to 175 to accommodate for standardization of creatinine assays over IDMS. The evidence doesn't seem to strongly suggest that the revised version is demonstrably better than the original (furthermore, the same authors of MDRD also developed the newerCKD-EPI equations, which are more accurate at a broader range of estimated GFR than the MDRD equations). *Race may/may not provide better estimates of GFR; optional.See herefor more on our approach to addressing race and bias on MDCalc.
evidence
Derived and validated in patients from the Modification of Diet in Renal Disease (MDRD) cohort by Levey et al in 1999. The derivation cohort included 1070 patients and the validation cohort 558 patients. The equation has since been validated more extensively in a variety of populations, though it remains useful primarily for patients with impaired kidney function (eGFR < 60 ml/min/1.73m). The equation has not been validated in patients greater than 70 years old, though it is still applied in these patients. Additional modifications exist for use in certain populations, including East Asian populations.
Debate has arisen regarding the use of the adjustment coefficient for black patients. The extent to which self-reported race may be considered a variable in physiologic calculations is currently being scrutinized, and several large health systems have now removed the race coefficient from eGFR calculations.
measurements
[ { "name": "Age", "unit": "age", "error_min": "0.001", "error_max": "120", "warn_min": "0.1", "warn_max": "100", "conversion": "1", "normal_max_si": "0", "normal_max_us": "0", "normal_min_si": "0", "normal_min_us": "0", "units_si": "years", "units_us": "years" }, { "name": "Creatinine", "unit": "cr", "error_min": "0.01", "error_max": "40", "warn_min": "0", "warn_max": "10", "conversion": "88.4", "normal_max_si": "115", "normal_max_us": "1.3", "normal_min_si": "62", "normal_min_us": "0.7", "units_si": "µmol/L", "units_us": "mg/dL" } ]
refrences
{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/10075613", "text": "Levey AS, Bosch JP, 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." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/658418", "text": "Levey AS, Greene T, Kusek JW, Beck GJ. A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol. 2000;11:A0828." }, { "href": "https://annals.org/aim/article-abstract/718024/using-serum-creatinine-estimate-glomerular-filtration-rate-accuracy-good-health?volume=141&issue=12&page=929#FN", "text": "Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med. 2004;141(12):929-37." }, { "href": "https://annals.org/aim/article-abstract/727341/using-standardized-serum-creatinine-values-modification-diet-renal-disease-study?volume=145&issue=4&page=247", "text": "Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247-54." } ], "Validations": [] }
pearls
- The MDRD equation cannot be used for acute renal failure. It is only useful in estimating glomerular filtration rate (GFR) in stable chronic kidney disease.
- Despite improvements to the MDRD equation, it tends to significantly underestimate measured GFR.
- Underestimation of GFR is particularly significant in patients with a GFR >60 ml/min/m2; 29% in healthy patients undergoing evaluation for kidney donation.
usecase
Patients with chronic kidney disease, to estimate kidney function.
reasons
Noninvasively estimates the measured GFR to determine degree or presence of decreased kidney function. The MDRD equation performs equally to the newerCKD-EPI Equationin patients with GFR of <60 ml/min/1.73m2. Performs superiorly to theCockcroft-Gault Equation.
next_advice
Patients with decreased GFR are at higher risk of progressive kidney disease. Management of contributing risk factors, such as diabetes and hypertension, is critical to slowing progression. Investigation of the underlying cause of decreased GFR is warranted if not clear from the history.
Medications should be dose-adjusted for the most recent available eGFR. In this setting, eGFR and creatinine clearance may be used interchangeably, though they are physiologically different terms. Cutoffs for many medications are <60, <45 and <30 ml/min/m2, as well as adjustments for advanced kidney disease and dialysis patients.
next_actions
next_management
Patients should be classified into CKD stage by both eGFR and albuminuria status. Patients with decreased GFR, increased urinary albumin excretion or both, are at high risk of progressive CKD and should be referred to nephrology for further management.
diseases
[ "Chronic Kidney Disease", "Diabetes Mellitus", "Renal Failure" ]
instructions
Only for chronic kidney disease (CKD); not accurate for acute renal failure. This calculator uses the 4-variable equation from Levey 2006, which relied on a standardized creatinine assay.
published
2022-04-21T20:29:46.587Z
purpose
[ "Formula" ]
search_terms
[ "cr", "crcl", "renal", "arf", "aki", "creatinine", "ckd", "crf", "egfr", "estimated gfr" ]
seo
{ "keywords_en": "MDRD GFR equation, mdrd, mdrd crcl, mdrd gfr, mdrd glomerular, mdrd filtration, mdrd equation, mdrd calc, mdrd score, mdrd gfr calc, mdrd equation, gfr equation, gfr estimate, gfr creatinine, gfr cr, gfr creatinine estimate, gfr mdrd estimate, mdrd glomerular filtration rate, mdrd glom, mdrd glom fil, gfr by age, gfr by race, gfr labs, gfr calcs, gfr score, gfr creatinine, mdrd creatinine, glomerular filtration, glomerular rate, gfr equation, gfr rate, mdrd rate, levey gfr, levey mdrd, levey equation, levey kidney equation, renal gfr, renal calc gfr, renal calculator mdrd, renal calculator gfr, renal calc mdrd", "meta_description_en": "The MDRD GFR Equation estimates glomerular filtration rate based on creatinine and patient characteristics." }
specialty
[ "Critical Care", "Endocrinology", "Family Practice", "Geriatrics", "Hospitalist Medicine", "Internal Medicine", "Nephrology", "Pharmacy", "Primary Care", "Radiology" ]
departments
[ "Endocrine and Metabolic", "Renal" ]
tags
[]
version_number
1
versions
[]
related
[ { "calcId": 43, "short_title_en": "Creatinine Clearance", "slug": "creatinine-clearance-cockcroft-gault-equation" }, { "calcId": 3939, "short_title_en": "CKD-EPI Equations for GFR", "slug": "ckd-epi-equations-glomerular-filtration-rate-gfr" }, { "calcId": 10008, "short_title_en": "Revised Schwartz Equation (2009)", "slug": "revised-schwartz-equation-glomerular-filtration-rate-gfr-2009" } ]
ismed
false
section
[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]
cleaned_departments
[ "endocrine", "urology" ]
cleaned_use
[ "Patients with chronic kidney disease, to estimate kidney function." ]
pub
true