The Cockroft-Gault equation is better than the MDRD equation for estimating glomerular filtration rate in patients with advanced chronic renal failure

The aim of this study was to compare the accuracy of three kidney function estimating equations: classic Cockcroft-Gault (classic CG), corrected Cockcroft-Gault (corrected CG) and simplified Modification of Diet in Renal Disease (MDRD), in patients with advanced chronic renal failure. The study was made in 84 nondialyzed patients with chronic renal disease in stage 4 or 5. The glomerular filtration rate was measured on a 24-hour urine collection as the arithmetic mean of the urea and creatinine clearances (CUrCr). In each patient, the difference between each estimating equation and the measured glomerular filtration rate was calculated. The absolute difference expressed as a percentage of the measured glomerular filtration rate indicates the intermethod variability. In the total group the glomerular filtration rate measured as the CUrCr was de 13.5 ± 5.1 ml/min/1.73 m; and the results of the estimating equations were: classic CG 14.2 ± 5 (p < 0.05); corrected CG 12 ± 4.2 (p < 0.01) and MDRD: 12.1 ± 4.8 ml/min/1.73 m (p < 0.01). The variability of the estimating equations was 15.2 ± 12.2%, 17.1 ± 13.4% and 19.3 ± 13.3% (p < 0.05), for classic CG, corrected CG and MDRD respectively. The percent of estimates falling within 30% above o below the measured glomerular filtration rate was 90% for CG classic, 87% for corrected CG and 79% for MDRD. The intraclass correlation coefficients respect to CUrCr were 0.86 for classic CG, 0.81 for corrected CG and 0.77 for MDRD. The MDRD variability, but not classic CG variability or corrected CG variability, showed a positive correlation with the glomerular filtration rate (r = 0.25, p < 0.05). In patients with chronic renal disease in stage 5, the variability of the different estimating equations was similar. We conclude that in our population with advanced chronic renal failure the classic CG equation is more accurate than the MDRD equation. Corrected CG equation has not any advantage respect to classic CG equation.