Many organizations recommend the use of equations that estimatethe glomerular filtration rate (GFR) to facilitate the detection,evaluation, and management of chronic kidney disease.1,2,3,4,5,6,7,8,9,10,11Indeed, many clinical laboratories already report estimatedGFR values whenever the serum creatinine level is measured.In this review, we discuss the strengths and weaknesses of currentmethods of measuring and estimating GFR as applied to chronickidney disease.
Chronic Kidney Disease
Chronic kidney disease has recently been recognized as a publichealth problem; it is estimated that by 2030, more than 2 millionpeople in the United States will need dialysis or transplantationfor kidney failure.12 Currently, . . . [Full Text of this Article]
Measurement of GFR with Exogenous Filtration Markers
Estimation of GFR with Endogenous Filtration Markers
Creatinine
Cystatin C
Equations Used to Estimate GFR
Evaluation of Current Estimating Equations
Use of GFR Estimates
Detection of Chronic Kidney Disease
Monitoring Progression of Chronic Kidney Disease
Evaluation and Management of Complications
GFR and Referral to Nephrologists
Medications and Chronic Kidney Disease
Assessment of Risk for Cardiovascular Disease
When to Consider Clearance Measurements Instead of Estimated GFR
GFR Reporting by Clinical Laboratories
Conclusions
Source Information
From the Division of Nephrology, Tufts–New England Medical Center, Boston (L.A.S., A.S.L.); the Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore (J.C.); and the Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland (T.G.).
Address reprint requests to Dr. Stevens at Tufts–New England Medical Center, 750 Washington St., Box 391, Boston, MA 02111, or at lstevens1@tufts-nemc.org.
Related Letters:
Measured and Estimated Glomerular Filtration Rate
Fein I. A., Mullany L., Walders W., Hebert L. A., Nori U., Hebert P. L., Mariat C., Alamartine E., Berthoux F., Spital A., Abuelo J. G., Stevens L. A., Levey A. S.
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N Engl J Med 2006;
355:1067-1070, Sep 7, 2006.
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