Purpose of review
Estimated GFR is now commonly reported by clinical laboratories. Here we review the performance of current creatinine and cystatin C based estimating equations as well as demonstration of their utility in public health and clinical practice.
Lower levels of GFR are associated with multiple adverse outcomes, including acute kidney injury and medical errors. The new CKD-EPI equation improves performance and risk prediction compared to the MDRD Study equation. Current cystatin C based equations are not accurate in all populations, even in those with reduced muscle mass or chronic illness, where cystatin C would be expected to outperform creatinine. eGFR reporting has led to a greater number of referrals to nephrologists, but the increased numbers do not appear to be excessive or burdensome The MDRD Study equation appears to be able to provide drug dosage adjustments similar to the Cockcroft and Gault.
Estimated GFR and their reporting can improve and facilitate clinical practice for chronic kidney disease. Understanding strengths and limitations facilitates their optimal use. Endogenous filtration markers, alone or in combination, that less dependent on non GFR determinants of the filtration markers are necessary to lead to more accurate estimated GFR.
Keywords: glomerular filtration rate, creatinine, cystatin, prognosis