Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae

F J Gifford, Shona Methven, D E Boag, E M Spalding, M S MacGregor

Research output: Contribution to journalArticle (Academic Journal)

20 Citations (Scopus)


Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EP formulae on prevalence estimates, and on secular
trends in prevalence.
We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009–10). To minimize the effect of acute illness, a patient’s lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with subgroup analysis by age and sex.
In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009–10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3–5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60–89 ml/min/1.73m2 and CKD stage 3A, in women, and in those <70 years old. 5172 patients (1.8%), mostly elderly women, were reclassified to more severe stages of CKD. Between the two time periods, the prevalence of CKD stages 3–5 rose from 5.44% to 5.63% of the population using MDRD4, but was static at 4.94% with CKD-EPI.
The CKD-EPI formulae, which are more accurate than the MDRD4 formula at higher GFR, reduced the estimated prevalence of CKD stages 3– 5 by 0.5% in 2004 and 0.7% in 2009–10. The greatest reclassification was seen in CKD 3A, particularly amongst middle-aged females. The minor rise in CKD prevalence between 2004 and 2009–10 seen with the MDRD4 formula was not confirmed with the CKD-EPI formulae. The CKD-EPI formulae may reduce overdiagnosis of CKD, but further assessment in the elderly is required before widespread implementation.
Original languageEnglish
Article number104
Pages (from-to)1045–1053
Number of pages9
Issue number12
Early online date5 Aug 2011
Publication statusPublished - Dec 2011

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