Open Access Research article

Differences in estimation of creatinine generation between renal function estimating equations in an Indian population: cross-sectional data from the Hyderabad arm of the Indian migration study

Phillippa K Bailey1*, Charles RV Tomson1, Sanjay Kinra2, Shah Ebrahim2, KV Radhakrishna3, Hannah Kuper2, Dorothea Nitsch2 and Yoav Ben-Shlomo4

Author Affiliations

1 The Richard Bright Renal Unit, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK

2 London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

3 National Institute of Nutrition, Hyderabad, India

4 School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

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BMC Nephrology 2013, 14:30  doi:10.1186/1471-2369-14-30

Published: 4 February 2013

Abstract

Background

Creatinine based formulae for estimating renal function developed in white populations may be less valid in other ethnic groups. We assessed the performance of various estimating formulae in an Indian population.

Methods

917 subjects were recruited from the Hyderabad arm of the Indian Migration Study. Data were collected on comorbidity, serum creatinine and body composition from DXA scans. Renal function was compared using the modified Cockcroft-Gault, MDRD and CKD-EPI formulae. 24-hour creatinine production was derived from each estimate and the agreement with measured muscle mass examined. 24-hour creatinine production estimates were compared to that derived from a formula by Rule incorporating DXA measured muscle mass. Potential systematic biases were examined by age and eGFR. We assessed the association of renal function by each formula with hypertension and self-reported measures of vascular disease.

Results

Mean modified Cockcroft-Gault eCCl was 98.8 ml/min/1.73 m2, MDRD eGFR 91.2 ml/min/1.73 m2 and CKD-EPI eGFR 96.3 ml/min/1.73 m2. MDRD derived 24-hour creatinine production showed the least age-related underestimation compared to the Rule formula. CKD-EPI showed a marked bias at higher eGFRs. All formulae showed similar strength associations with vascular disease and hypertension.

Conclusions

Our analyses support the use of MDRD for estimating renal function in Indian populations. Further work is required to assess the predictive value of formulae for incident disease and complications of CKD.

Keywords:
Creatinine; Ethnicity; Muscle mass; Renal function