Nephrol Dial Transplant (2011) 26: 2793–2798
doi: 10.1093/ndt/gfq849
Advance Access publication 9 February 2011
Definition of chronic kidney disease and measurement of kidney
function in original research papers: a review of the literature
Jocelyn Anderson and Liam G. Glynn
Discipline of General Practice, National University of Ireland, Galway, Ireland
Correspondence and offprint requests to: Liam G. Glynn; E-mail: liam.glynn@nuigalway.ie
Abstract
Background. Over the past decade, chronic kidney disease
(CKD) has become an area of intensive clinical and epide-
miological research. Despite the clarity provided by the
Kidney Disease Outcomes Quality Initiative (KDOQI)
guidelines, there appears to be within the CKD research
literature significant disagreement on how to define CKD
and measure kidney function.
Methods. The objectives of this study were to investigate
the variety of methods used to define CKD and to measure
kidney function in original research papers as well as to
investigate whether the quality of the journal had any effect
on the quality of the methodology used.
This was a descriptive review and not a meta-analysis.
Information was extracted from each article including pub-
lication details (including the journal’s impact factor), def-
inition of CKD, method used to estimate kidney function
and quantity of serum creatinine readings used to define
CKD.
An electronic search of MEDLINE through OVID was
completed using the search term CKD. The search was
limited to articles in English published in 2009.
Studies were included in the review only if they were
original research articles including patients with CKD.
Articles were excluded if they reported data from a paedi-
atric population, a population solely on dialysis or if there
was no full-text access through OVID.
Each article was assessed for quality with respect to
using KDOQI CKD definition criteria.
A description of the pooled data was completed and chi-
square tests were used to investigate the relation between
article quality and journal quality. Analysis was carried out
using SPSS (15.0) and a P-value of <0.05 was considered
to indicate statistical significance.
Results. The final review included 301 articles. There
were a variety of methods used to define CKD in original
research articles. Less than 20% (n ¼ 59) of the articles
adhered to the established international criteria for defin-
ing CKD. The majority of articles (52.1%) did not indicate
the quantity of serum creatinine measurements used to
define CKD. The impact factor or specialist nature of
the scientific journal appears to have no bearing on

The Author 2011. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com
whether or not published articles use the gold standard
KDOQI guidelines for labelling a patient with a diagnosis
Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015
of CKD.
Conclusions. This review of literature found that a variety
of definitions are being used in original research articles to
define CKD and measure kidney function which calls into
question the validity and reliability of such research findings
and associated clinical guidelines. International consensus is
urgently required to improve validity and generalizability of
CKD research findings.
Keywords: chronic kidney disease; classification; eGFR; MDRD
Introduction
Over the past decade, chronic kidney disease (CKD) has
become an area of intensive clinical and epidemiological
research. Historically, the CKD research literature has
struggled to create consensus on definitions of CKD [1, 2]
that has made the reporting of CKD research problematic
[3]. This situation appeared to be resolved when in 2002 the
National Kidney Foundation’s Kidney Disease Outcomes
Quality Initiative (KDOQI) created guidelines providing a
clear definition and classification system for CKD [4]. These
guidelines define CKD as the presence of kidney damage
or glomerular filtration rate (GFR) of <60 mL/min/1.73m2
for <3 months. CKD is further classified into Stages I–V
according to the estimated GFR (eGFR) (Table 1).
The KDOQI clinical practice guidelines appeared to
bring order to the previously chaotic terminology used
within CKD research and clinical practice [5]. However,
the guidelines have not existed without their critics and
requests for amendments [6, 7]. Arguments have been
proposed for increasing the ‘chronic’ aspect of the defini-
tion by increasing the 3-month time frame in the KDOQI
guidelines to longer time intervals, such as 6, 9 or 12
months [8]. Despite this push for lengthening the chron-
icity aspect of the CKD definition, many large CKD prev-
alence and mortality risk studies including the National
Health and Nutrition Examination Survey have chosen
to use only one serum creatinine reading to define
2794
CKD—thereby neglecting the chronicity which is inherent
in this disease [9, 10].
There has also been much debate regarding the best
method of measuring kidney function. The gold standard
of assessing kidney function is direct measurement of GFR
through 24-h urine collection. However, this is not practical
in many settings; consequently, equations are used to cal-
culate eGFR in lieu of direct measurement. The two equa-
tions most frequently used for estimated kidney function
are the Modified Diet in Renal Disease (MDRD) Study
equation [11] for estimating GFR and the Cockcroft-Gault
equation [12] for determining creatinine clearance (CrCl).
The MDRD equation dominates in epidemiological studies
[13] and clinical lab use [14–17] when estimating GFR.
The Cockcroft-Gault equation has historically been recom-
mended for use when calculating medication dosages; how-
ever, the MDRD equation has recently become acceptable
for this purpose as well [18–20]. Choosing which equation
to use in which circumstance is not clear-cut and both
equations are still criticized for biases and inaccuracy [21,
22]. Newer equations have been proposed to overcome the
limitations of the MDRD and Cockcroft-Gault equations.
The CKD-EPI (Chronic Kidney Disease Epidemiology
Collaboration) formula [23], Mayo quadratic equation
[24] and cystatin C-based equations [25–27], respectively,
claim to be more accurate [23], reliable [28] and supe-
rior [29] to the MDRD and Cockcroft-Gault equations
especially in patients with higher GFR levels.
As discussed above, there is a lack of agreement within
the literature regarding how to define CKD and estimate
GFR despite the clear guidelines from KDOQI. One pre-
vious study performed a preliminary Google search of the
term ‘chronic kidney disease’ and found an absence of any
consistent definition [2]. It is apparent that variations in the
definition of a disease within research will have implications
for further research along with potential implications for
practice. To the best of our knowledge, there has not been
a systematic review of literature that describes or quantifies
the variation of CKD definitions used in original research
articles. In light of this, the aim of this study was to provide
a description and estimation of the variety of methods used to
define CKD and measure kidney function in original research
papers that have been published in the year 2009. A secon-
dary objective was to investigate whether the quality of the
journal, in which the article was published, had any effect on
the quality of the methodology used to define CKD.
Methods
Literature search
An electronic search of MEDLINE through OVID was completed on 12
January 2010. The search term ‘chronic kidney disease’ was used and the
search was further limited to articles in English and those published in 2009.
Inclusion/exclusion criteria
To be included in the review, a study had to be an original research article
and include patients with CKD. Articles were excluded from the analysis if
studies reported data from a paediatric population due to the fact that
kidney function is calculated differently from an adult population. Studies
were also excluded if they reported data solely from a population on
dialysis (peritoneal or haemodialysis) as discrepancies in CKD definition
are futile at this stage. Review articles, commentaries, case reports and
studies with a non-human population were also excluded. Articles that did
J. Anderson and L.G. Glynn
Table 1. The stages of CKD as outlined by the National Kidney
Foundation Kidney Disease Outcomes Quality Initiative [4]
Stage Clinical features GFR (mL/min/1.73m2)
I a
Kidney damage with normal 90
or increased GFR
a
II Kidney damage with a mild 60–89
decrease in GFR
III Moderate decrease in GFR 30–59
IV Severe decrease in GFR 15–29
V Kidney failure <15 or dialysis
a
Kidney damage ¼ pathologic abnormalities or markers of disease present
in the urine, blood or on imaging modalities.
not use the term ‘chronic kidney disease’ but used other terms i.e. ‘patients
with low eGFR’ in reference to their study population were also excluded.
Articles that were deemed potentially appropriate for review based on their
abstracts but did not have full-text access via OVID were also excluded.
Data extraction
Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015
Abstracts and titles were screened by both authors (J.A. and L.G.G.) and
for those considered potentially relevant full-text versions were obtained to
ensure that studies met the selection criteria. The following information
was extracted from each article which met inclusion criteria: publication
details, the study’s definition of chronic kidney disease, method used to
calculate eGFR or CrCl, minimum number of readings (i.e. readings of
serum creatinine) and time between readings necessary to define chronic
kidney disease, method used to determine proteinuria or albuminuria, if
applicable, and method used to determine structural kidney damage, if
applicable. The impact factor of each journal included in the review was
obtained for 2009 [30]. Journals without impact factors were allocated
a value of <1. Journals that were included in the analysis were also sep-
arated into one of two groups: specialist or general journals. Specialist
journals were defined as those dedicated specifically to kidney or urol-
ogy research. No distinction was made between included studies on the
basis of whether CKD was defined for the purposes of selecting a study
cohort, evaluating CKD as an exposure or studying CKD as an
outcome.
Outcomes
Each article was assessed for quality as defined by the authors of this paper
described below. A marker of good article quality was the use of KDOQI
CKD definition criteria i.e. the article had to indicate that for the purpose of
their study, CKD was defined using KDOQI criteria or that CKD patients
had kidney function (i.e. GFR, eGFR, CrCl) measured on a minimum of
two occasions separated by a minimum period of 3 months. A marker of
poor article quality was the lack of mentioning any CKD definition used
for the purpose of the article.
Statistical analysis
This review was not a meta-analysis. A description of the pooled data
was completed and is summarized in Tables 2 and 3. Quality of the
journal (as represented by impact factor and journal type) and its relation
to article quality (as described above) was analysed by chi-square anal-
yses and are summarized in Table 4. Quartiles were determined for the
impact factor values and journals were grouped accordingly. Journals
were categorized into four groups according to the value of their impact
factor. All statistical test values were two sided, and a P-value of <0.05 was
considered to indicate statistical significance. Analysis was carried out using
SPSS (15.0).
Results
Studies identified by the literature search
The literature search identified 1158 articles from the initial
search term and search criteria and Figure 1 shows the
flowchart of the progress of articles in the review. Upon
Definition of CKD in original research papers 2795
Table 2. Methodology used to define CKD in original research articles Table 3. Quantity of serum creatinine readings and methods of kidney
function estimation used for defining CKD in original research articles
A. CKD definition n %
Number of readings required to meet n %
eGFR alone 144 47.8 CKD definition
Unknown 26 8.6 2 readings separated by 3 months a,b 60 20.0
According to KDOQIa 26 8.6 Not specified 157 52.1
CrCl alone 19 6.3 1 reading 61 20.3
eGFR Albuminuria and 5 1.7 2 readings separated by <3 months 3 1.0
or 4 1.3 2 readings with no time specification 3 1.0
and/or 11 3.6 between readings
Proteinuria and 5 1.7 Not applicablec 17 5.6
or 10 3.3 Total 301 100
and/or 2 0.7 eGFR/CrCl calculation method n %
Structural Damage and 2 0.7 MDRD
or 2 0.7 Version unspecified 74 24.6
and/or 3 1.0 4v MDRD 80 26.6
Documented ICD code 9 3.0 6v MDRD 8 2.7
diagnosis Written in chart 5 1.7 MDRD with Chinese coefficient 4 1.3
NKF database 2 0.7 MDRD with Japanese coefficient 14 4.7
Clinic database 2 0.7 MDRD with UK coefficient 2 0.7
GFR 9 3.0 MDRD with study-derived coefficient 4 1.3
CrCl or albuminuria 1 0.3 Not applicabled 36 11.9
or proteinuria 1 0.3 Unknown 35 11.6

Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015

and/or structural damage 2 0.7 Cockcroft-Gault 21 7.0
and/or SCr 2 0.7 More than one equation used
SCr alone 3 1.0 MDRD 1 Cockgroft-Gault 7 2.3
SCr and/or proteinuria 1 0.3 MDRD 1 CKD-EPI 1 0.3
and documented diagnosis 2 0.7 4vMDRD 1 Cystatin C-based equation 5 1.7
Structural damage 3 1.0 4vMDRD 1 Mayo Quadratic equation 1 0.3
alone MDRD 1 0.3
Total 301 100 24-h urine collection 5 1.7
B. How structural n % 24-h urine collection and/or Cockcroft-Gault 2 0.7
damage was definedb Mayo Quadratic equation 1 0.3
Not specified 4 33.3 Total 301 100
Clinical history 3 25.0 a
Markers of kidney 1 8.3 KDOQI criteria for defining CKD.
b
damage If the original definition of CKD was defined as ‘according to KDOQI
Biopsy or imaging 1 8.3 criteria’, then it was assumed that a minimum of two kidney function
Biopsy or markers of 1 8.3 measurements were made 3 months apart in keeping with the criteria
kidney damage even if the article did not explicitly state this in their methodology.
c
Biopsy, imaging or markers 1 8.3 When CKD was defined by structural damage alone or by a documented
of kidney damage diagnosis alone.
d
Biopsy, imaging or clinical history 1 8.3 When CKD was defined using GFR, by structural damage alone, SCr or a
Total 12 100 documented diagnosis alone.

a
‘According to KDOQI’ was the only stated information when referring to
the methodology of defining CKD.
b
In articles that used structural damage as a criterion for CKD definition.
review of article titles and abstracts, 412 articles were
deemed potentially relevant based on the aforementioned
criteria. It was possible to obtain online full-text access for
334 articles. Of the 334 full articles, 301 were included in
the final review. The final review included articles from
123 different journals.
CKD definition used in original research articles
There were 26 different methods used to define CKD
(Table 2, panel A). Less than half of the articles (47.8%)
defined CKD by using solely an eGFR value. An additional
44 articles (14.6%) used eGFR in combination with another
estimation of kidney damage (i.e. albuminuria, proteinuria
or structural damage). A substantial number of articles
(n ¼ 26) did not indicate how they defined CKD for the
purposes of their research. Of the articles that used struc-
tural damage as a CKD definition criterion, one-third
(n ¼ 4) did not specify how they determined this structural
damage (Table 2, panel B).
Kidney function estimation used in original research
articles
The quantity and duration of time between serum creatinine
measurements also varied greatly between research articles
(Table 3). The gold standard of CKD definition as defined by
KDOQI as two eGFR readings <60 mL/min/1.73m2 sepa-
rated by 3 months was adhered to in only 20% (n ¼ 60) of the
articles. The majority of articles (52.1%) did not indicate any
further information about serum creatinine measurements
used to define CKD for the purposes of their research. Of
the articles that did specify the number of creatinine meas-
urements used to define CKD (n ¼ 127), 48% (n ¼ 61) only
used one reading. Estimating GFR or CrCl was done using
solely the MDRD equation in 62% of the articles (n ¼ 181).
The remainder used either the Cockcroft-Gault equation
(7%) or did not indicate the method used to estimate GFR
or CrCl (11.6%).
Article quality versus journal quality or type
The influence of journal characteristics on the quality of
article methodology is shown in Table 4. Chi-square
2796 J. Anderson and L.G. Glynn
Table 4. Impact factor and specialist nature of journal and CKD definition in original research articles

Journal characteristics
Definitions
Impact factors P-value

1.716 1.717–3.306 3.307–5.103 5.104

KDOQI CKD definition 17/76 (22%) 18/92 (20%) 8/58 (14%) 16/75 (21%) 0.625
CKD definition stated 69/76 (91%) 82/92 (89%) 54/58 (93%) 70/75 (93%) 0.752
Specialist journala General journal
KDOQI CKD definition 31/157 (20%) 28/144 (19%) 0.948
CKD definition stated 146/157 (93%) 129/144 (89%) 0.293
a
Specialist journal is defined as a journal dedicated to kidney or urology research.

creatinine readings taken, the majority defined CKD by

using only one reading (n ¼ 61), thus disregarding the
inherent chronicity of the disease. The impact factor or
specialist nature of the scientific journal appears to have
no bearing on whether or not published articles use the
gold standard KDOQI guidelines for labelling a patient

Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015

with a diagnosis of CKD.

Comparison with existing literature

It is surprising that despite the existence of an international
CKD definition, researchers instead have chosen to use
the spectrum of definitions found during this review. It
was known prior to commencing this review that many
community-based cohort CKD studies used only one serum
creatinine reading to define CKD [10]. This finding was re-
enforced with the results of this review. Choosing to use
only one serum creatinine reading to define CKD has been
shown to overestimate the CKD population by up to 30%
[8]. Alternatively, choosing to use a documented diagnosis
of CKD to define a CKD population has been shown to
drastically underestimate the CKD population [31]. There-
fore, by choosing alternative ways to define CKD, the val-
idity of the research findings is questionable as are the
guidelines that emanate from such research.

Strengths and limitations

Fig. 1. Flowchart of articles in the review.
analyses showed no significant difference in the effect of the
impact factor on the quality of definitions used (P ¼ 0.625).
There were 23 different specialist journals in total. Spe-
cialist journals published 52% (n ¼ 157) of the articles
analysed in this study but the quality of the CKD definition
was not significantly different in specialist versus generalist
journals (P ¼ 0.948).
Discussion
Summary of main findings
There is a variety of ways that authors are choosing to
define CKD for the purposes of their own research. Less
than 20% (n ¼ 59) of the articles included in this review
adhered to the established international criteria for defin-
ing CKD. Of the articles that did specify the number of
This study represents the first comprehensive review of
definitions of CKD used in original research articles and
provides insight into the lack of consistency within CKD
research. However, this study has a number of limitations.
Firstly, our exclusion criteria limited the number of articles
that were reviewed. Articles that did not use the term
‘chronic kidney disease’ but used other terms i.e. ‘patients
with low eGFR’ in reference to their study population were
excluded. Secondly, articles without full-text access were
excluded. Thirdly, our search strategy only allowed for
articles from the year 2009 to be accessed which may or
may not allow for our findings to be generalizable to other
years of published research. Finally, assumptions about
chronicity of low eGFR and persistence of proteinuria
may differ based on whether measurements were made as
outpatients versus inpatients or whether measurements
were done in a prospective protocolized manner versus
collected in a retrospective manner. However, these data
were often unavailable and were not collected as part of the
current study.
Definition of CKD in original research papers
Implications for future research and clinical practice
In order to ensure that research is interpretable and able to
be built on in future research, definitions and terminology
used must be consistent. The lack of consistency in defin-
ing CKD in research articles published in 2009 questions
the reliability of conclusions made regarding CKD patients.
Additionally, the majority of research articles are not clar-
ifying the methodology used to define CKD—which may
have implications for future research and possibly clinical
practice. Many physicians are unsure of how to diagnose
CKD in the clinical context [32] and certainly current re-
search practices are not helping to clarify this uncertainty.
In addition to those differences identified in this study,
several other distinctions between studies such as those
relating to construct and predictive validity will need to
be considered. However, it is important to note that the
implications of these differences on internal and external
validity in CKD research remains uncertain. Therefore,
recognizing that the current CKD definition and staging
may evolve, definitions for CKD should be developed,
validated and operationalized for research purposes in a
timely manner through international consensus. However,
once this has taken place, the implications (i.e. selection
bias, misclassification, confounding factors) of defining
study populations, exposure and outcomes according to a
proposed CKD definition must be rigorously examined.
Conclusions
This review of literature found that a variety of definitions are
being used in original research articles to define CKD. This
calls into question the validity and reliability of some CKD
research findings as well as the clinical guidelines that have
emerged from such research. International consensus in CKD
definitions is urgently required to rectify this situation and
ensure further CKD research is valid, clinically applicable
and generalizable to primary and secondary care.
Conflict of Interest Statement. All authors declare no conflict of interest.
J.A. and L.G.G. do not have support from any company for their submitted
work and do not have any non-financial interests that may be relevant to
the submitted work. The results presented in this paper have not been
published previously either in whole or part.
Author’s Contributions: J.A. (guarantor), L.G.G. both contributed to
study conception and design. J.A. was responsible for the acquisition of
data while L.G.G. and J.A. analysed the data and drafted the article. Both
authors had full access to all of the data in the study and can take respon-
sibility for the integrity of the data and the accuracy of the data analysis.
Both authors revised the article and granted final approval to the version
submitted for publication.
Ethics Approval: Ethics approval was not required for this study.
Funding: This study was supported by a bursary from the Western
Research and Education Network (WestREN). This bursary was received
through a peer-reviewed application process from which all authors remain
independent and the authors’ work was carried out independently of the
funding organization.
References
1. Hsu CY, Chertow GM. Chronic renal confusion: insufficiency, fail-
ure, dysfunction, or disease. Am J Kidney Dis 2000; 36: 415–418
2. Ridley J, Baker J, Mills C et al. Chronic kidney disease: what’s in a
name? CANNT J 2009; 19: 19–22
2797
3. Jones CA, McQuillan GM, Kusek JW et al. Serum creatinine levels in
the US population: third National Health and Nutrition Examination
Survey. Am J Kidney Dis 1998; 32: 992–999
4. National Kidney Foundation. K/DOQI clinical practice guidelines for
chronic kidney disease: evaluation, classification, and stratification.
Am J Kidney Dis 2002; 39: S1–S266
5. Glassock RJ, Winearls C. An epidemic of chronic kidney disease: fact
or fiction? Nephrol Dial Transpl 2008; 23: 1117–1121
6. Go AS, Chertow GM, Fan D et al. Chronic kidney disease and the
risks of death, cardiovascular events, and hospitalization. N Engl
J Med 2004; 351: 1296–1305
7. O’Hare AM, Bertenthal D, Covinsky KE et al. Mortality risk strat-
ification in chronic kidney disease: one size for all ages? J Am Soc
Nephrol 2006; 17: 846–853
8. Eriksen BO, Ingebretsen OC. In chronic kidney disease staging the
use of the chronicity criterion affects prognosis and the rate of
progression. Kidney Int 2007; 72: 1242–1248
9. Coresh J, Astor BC, Greene T et al. Prevalence of chronic kidney
disease and decreased kidney function in the adult US population:
third National Health and Nutrition Examination Survey. Am J Kidney
Dis 2003; 41: 1–12
10. Weiner DE, Krassilnikova M, Tighiouart H et al. CKD classifica-
tion based on estimated GFR over three years and subsequent cardiac
Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015
and mortality outcomes: a cohort study. BMC Nephrol 2009; 10: 26
11. Levey AS, Bosch JP, Lewis JB et al. A more accurate method to
estimate glomerular filtration rate from serum creatinine: a new pre-
diction equation. Modification of Diet in Renal Disease Study Group.
Ann Intern Med 1999; 130: 461–470
12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from
serum creatinine. Nephron 1976; 16: 31–41
13. Levey AS, Andreoli SP, DuBose T et al. Chronic kidney disease:
common, harmful, and treatable—World Kidney Day 2007. Clin
J Am Soc Nephrol 2007; 2: 401–405
14. Miller WG. Reporting estimated GFR: a laboratory perspective. Am
J Kidney Dis 2008; 52: 645–648
15. Jones GR, Mathew T, Johnson D et al. Implementation of the routine
reporting of eGFR in Australia and New Zealand. Scand J Clin Lab
Invest Suppl 2008; 241: 23–29
16. Lamb EJ. United Kingdom guidelines for chronic kidney disease.
Scand J Clin Lab Invest Suppl 2008; 241: 16–22
17. Narva AS. The National Kidney Disease Education Program and
other related efforts in the United States. Scand J Clin Lab Invest
Suppl 2008; 241: 12–15
18. Administration FaD. Guidance for Industry: Pharmacokinetics in
Patients with Impaired Renal Function-Study Design, Data Analysis,
and Impact on Dosing and Labeling. http://www.fda.gov/downloads/
Drugs/GuidanceComplianceRegulatoryInformation/Guidances/
UCM204959.pdf. (5 July 2010, date last accessed)
19. Hermsen ED, Maiefski M, Florescu MC et al. Comparison of the
Modification of Diet in Renal Disease and Cockcroft-Gault equations
for dosing antimicrobials. Pharmacotherapy 2009; 29: 649–655
20. National Institutes of Health NKDEP. Chronic Kidney Disease and
Drug Dosing: Information for Providers. http://www.nkdep.nih.gov/
professionals/CKD_DrugDosing_508.pdf. (5 July 2010, date last
accessed)
21. Glassock RJ. Estimated glomerular filtration rate: time for a perform-
ance review? Kidney Int 2009; 75: 1001–1003
22. Singh NP, Ingle GK, Saini VK et al. Prevalence of low glomerular
filtration rate, proteinuria and associated risk factors in North India using
Cockcroft-Gault and Modification of Diet in Renal Disease equation: an
observational, cross-sectional study. BMC Nephrol 2009; 10: 4
23. Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate
glomerular filtration rate. Ann Intern Med 2009; 150: 604–612
24. Rule AD, Larson TS, Bergstralh EJ et al. Using serum creatinine
to estimate glomerular filtration rate: accuracy in good health and in
chronic kidney disease. Ann Intern Med 2004; 141: 929–937
25. Hoek FJ, Kemperman FA, Krediet RT. A comparison between cys-
tatin C, plasma creatinine and the Cockcroft and Gault formula for the
estimation of glomerular filtration rate. Nephrol Dial Transpl 2003;
18: 2024–2031
2798
26. Larsson A, Malm J, Grubb A et al. Calculation of glomerular filtration
rate expressed in mL/min from plasma cystatin C values in mg/L.
Scand J Clin Lab Invest 2004; 64: 25–30
27. Stevens LA, Coresh J, Schmid CH et al. Estimating GFR using serum
cystatin C alone and in combination with serum creatinine: a pooled
analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008; 51:
395–406
28. Marsik C, Endler G, Gulesserian T et al. Classification of chronic
kidney disease by estimated glomerular filtration rate. Eur J Clin
Invest 2008; 38: 253–259
29. Fontsere N, Esteve V, Saurina A et al. The search for a new marker of
renal function in older patients with chronic kidney disease stages 3-4:
J. Anderson and L.G. Glynn
usefulness of cystatin C-based equations. Nephron Clin Pract 2009;
112: c164–c170
30. Reuters T. Journal Citation Reports, ISI Web of Knowledge. 2009
edn., 2010
31. Glynn LG, Anderson J, Reddan D et al. Chronic kidney disease in
general practice: prevalence, diagnosis, and standards of care. Ir Med
J 2009; 102: 285–288
32. Duru OK, Vargas RB, Kermah D et al. High prevalence of stage 3
chronic kidney disease in older adults despite normal serum creatinine.
J Gen Intern Med 2009; 24: 86–92
Received for publication: 2.11.10; Revised December 1, 2010; Accepted in
revised form: 24.12.10
Downloaded from http://ndt.oxfordjournals.org/ by guest on November 15, 2015