Skip to main content
Article thumbnail
Location of Repository

Assessment of GFR by four methods in adults in Ashanti, Ghana : the need for an eGFR equation for lean African populations

By John B. Eastwood, Sally M. Kerry, Jacob Plange-Rhule, Frank B. Micah, Sampson Antwi, Frances G. Boa, Debashis Banerjee and Francesco Cappuccio


Background. Equations for estimating glomerular filtration rate (GFR) have not been validated in Sub-Saharan African populations, and data on GFR are few. \ud \ud Methods. GFR by creatinine clearance (Ccr) using 24-hour urine collections and estimated GFR (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD-4)[creatinine calibrated to isotope dilution mass spectrometry (IDMS) standard], Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft–Gault equations were obtained in Ghanaians aged 40–75. The population comprised 1013 inhabitants in 12 villages; 944 provided a serum creatinine and two 24-hour urines. The mean weight was 54.4 kg; mean body mass index was 21.1 kg/m2. \ud \ud Results. Mean GFR by Ccr was 84.1 ml/min/1.73m2; 86.8% of participants had a GFR of 60 ml/min/1.73m2. Mean MDRD-4 eGFR was 102.3 ml/min/1.73m2 (difference vs. Ccr, 18.2: 95% CI: 16.8–19.5); when the factor for black race was omitted, the value (mean 84.6 ml/min/1.73m2) was close to Ccr. Mean CKD-EPI eGFR was 103.1 ml/min/1.73m2, and 89.4 ml/min/1.73m2 when the factor for race was omitted. The Cockcroft–Gault equation underestimated GFR compared with Ccr by 9.4 ml/min/1.73m2 (CI: 8.3–10.6); particularly in older age groups. GFR by Ccr, and eGFR by MDRD-4, CKD-EPI and Cockcroft–Gault showed falls with age: MDRD-4 5.5, Ccr 7.7, CKD-EPI 8.8 and Cockcroft–Gault 11.0 ml/min/1.73m2/10 years. The percentage of individuals identified with CKD stages 3–5 depended on the method used: MDRD-4 1.6% (7.2 % without factor for black race; CKD-EPI 1.7% (4.7% without factor for black race), Ccr 13.2% and Cockcroft–Gault 21.0%. \ud \ud Conclusions. Mean eGFR by both MDRD-4 and CKD-EPI was considerably higher than GFR by Ccr and Cockcroft–Gault, a difference that may be attributable to leanness. MDRD-4 appeared to underestimate the fall in GFR with age compared with the three other measurements; the fall with CKD-EPI without the adjustment for race was the closest to that of Ccr. An equation tailored specifically to the needs of the lean populations of Africa is urgently needed. For the present, the CKD-EPI equation without the adjustment for black race appears to be the most useful. \ud \u

Topics: RC
Publisher: Oxford University Press
Year: 2010
OAI identifier:

Suggested articles


  1. (2006). A community programme to reduce salt intake and blood pressure
  2. (2002). A community study of health promotion in rural West Africa: details of a household survey and population census. doi
  3. (1916). A formula to estimate the approximate surface area if height and weight are known. Arch Intern Med doi
  4. (1999). A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med doi
  5. (2003). A nephrological program in Benin and Togo, West Africa. Kidney Int doi
  6. (2009). A new equation to estimate glomerular filtration rate. Ann Intern Med doi
  7. (2005). Andresdottir MB et al.P r e v a l e n c eo f chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults. Nephrol Dial Transplant doi
  8. (2005). Blood pressure and body mass index in lean rural and semi-urban subjects in West Africa. doi
  9. (2003). Chronic hemodialysis in a Nigerian teaching hospital: practice and costs. doi
  10. (2005). Chronic kidney disease: the global challenge. Lancet doi
  11. (2004). detection, management, and control of hypertension in Ashanti, West Africa. Hypertension doi
  12. (2002). Disease Outcome Quality Initiative. Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification and stratification. doi
  13. (2004). Drawbacks of the use of indirect estimates of renal function to evaluate the effect 2186 J.B. Eastwood et al.of risk factors on renal function.
  14. (2003). End-stage renal disease in sub-Saharan and South Africa. Kidney Int doi
  15. (2005). Estimation of Renal function in subjects with normal serum creatinine levels: influence of age and body mass index. doi
  16. (1999). Hypertension and renal failure in doi
  17. (1976). Prediction of creatinine clearance from serum creatinine. Nephron doi
  18. (2005). Predictive performance of the Modification of Diet in Renal Disease and Cockcroft–Gault equations for estimating renal function. doi
  19. (1990). Presentation and clinical course of Endstage renal failure in Ghana. A preliminary prospective study.
  20. (2005). Prevention of chronic kidney disease: a global challenge. Kidney Int doi
  21. (2005). Relationship of gender, age, and body mass index to errors in predicted kidney function. Nephrol Dial Transplant doi
  22. (2003). Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, doi
  23. (2005). Rural and semi-urban differences in salt intake, and its dietary sources, in Ashanti, West Africa. Ethn Dis
  24. (2005). Serum creatinine as marker of kidney function in South Asians: a study of reduced GFR in adults in Pakistan. doi
  25. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet doi
  26. (2007). Tet alFor Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate with standardised serum creatinine values. Clin Chem doi
  27. (1976). The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. doi
  28. (2005). The epidemiology of chronic kidney disease. Kidney Int doi
  29. (2003). The World Health Report. Shaping the future. WHO
  30. (2009). UK guidelines for GFR estimations: guidance for creatinine slopes and intercepts.
  31. (2004). Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.