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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Improving the understanding, detection, and management of kidney disease.

Estimate Glomerular Filtration Rate (GFR)

Calculate estimated GFR (eGFR) from serum creatinine levels to assess kidney function.

Use of any serum creatinine-based estimate requires that kidney function be at a steady state. eGFR should be used with caution in acutely ill or hospitalized patients who may exhibit rapidly changing kidney function.

Adults: Use either the Modification of Diet in Renal Disease (MDRD) Study equation or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Patients under the age of 18: Calculate eGFR using the Schwartz equation for patients under age 18.

Caution: It is important to know the method used to measure creatinine in a blood, serum, or plasma sample, as it will affect the formula for estimating GFR in children. Determine which calculator to use.

Reasons for Using the MDRD Study or CKD-EPI Equation to Estimate GFR

Because mild and moderate kidney injury is poorly inferred from serum creatinine alone, NKDEP strongly recommends the use of either the MDRD Study or CKD-EPI equation to estimate GFR from serum creatinine in adults. NKDEP also encourages clinical laboratories to routinely estimate GFR and report the value when serum creatinine is measured for patients 18 and older, when appropriate and feasible.

Assessing GFRs above 60 mL/min/1.73 m2

A laboratory that reports eGFR numeric values > 60 mL/min/1.73 m2 should use the CKD-EPI equation, because the CKD-EPI equation is more accurate for values > 60 mL/min/1.73 m2 than is the MDRD Study equation. However, the influence of imprecision of creatinine assays on the uncertainty of an eGFR value is greater at higher eGFR values and should be considered when assessing eGFR values > 60 mL/min/1.73 m2.

GFR Limitations

Estimated glomerular filtration rate (eGFR) calculated using either the MDRD Study equation or the CKD-EPI equation is an estimate of GFR, not the actual GFR. Both equations were derived from large population studies and will generate an estimate of the mean GFR in a population of patients with the same age, gender, race, and serum creatinine. However, the actual GFRs of those individuals will be distributed around that eGFR. An analogous estimate would be the estimated date of confinement for a pregnant woman based on her last menstrual period. This is the best estimate of the delivery date but, in fact, only a small minority of women actually deliver on that date.

When Not to Use the Creatinine-based Estimating Equations: Although the best available tool for estimating kidney function, eGFR derived from the MDRD Study or CKD-EPI equations may not be suitable for all populations. All creatinine-based estimates of kidney function are only useful when renal function is stable. Serum creatinine values obtained while kidney function is changing will not provide accurate estimates of kidney function.

Additionally, the equations are not recommended for use with:

Application of either the MDRD Study or CKD-EPI equation to these patient groups may lead to errors in GFR estimation. GFR-estimating equations have poorer agreement with measured GFR for ill hospitalized patients and for people with near normal kidney function than for the patients in the MDRD or CKD-EPI Study.

Page last updated: April 28, 2015