Estimating glomerular filtration rate: Performance of the CKD-EPI equation over time in patients with type 2 diabetes

J Diabetes Complications. 2016 Jan-Feb;30(1):49-54. doi: 10.1016/j.jdiacomp.2015.08.025. Epub 2015 Sep 8.


Aims: To assess the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at baseline and longitudinally in people with type 2 diabetes.

Methods: Adults with type 2 diabetes attending Austin Health, Melbourne, with≥3 prospective GFR measurements were included in this retrospective study. Plasma disappearance rate of DTPA (diethylene-triamine-penta-acetic acid) was used to calculate measured GFR (mGFR) and compared to estimated GFR (eGFR). The agreement between mGFR and eGFR was estimated using Intraclass Correlation Coefficient (ICC).

Results: 152 patients had a median of 4 (IQR: 3, 5) mGFR measurements over a period of 11years (IQR: 9, 12). The difference between mGFR and eGFR increased proportionally to the magnitude of the GFR, increasing by 0.2ml/min/1.73m(2) for every 1ml/min/1.73m(2) increase in mGFR, indicative of proportional bias. At lower mGFR levels, eGFR overestimated mGFR, and at higher mGFR levels, eGFR underestimated mGFR. There was a significant association between LDL cholesterol, triglycerides, HbA1c, diastolic blood pressure and the difference between mGFR and eGFR.

Conclusions: The CKD-EPI formula underestimates mGFR and the rate of decline of mGFR in patients with type 2 diabetes with an mGFR greater than 60ml/min/1.73m(2). The association between LDL cholesterol, triglycerides, HbA1c, diastolic blood pressure and the difference between mGFR and eGFR warrants further study.

Keywords: CKD-EPI; Estimated GFR; Measured GFR; Renal function; Type 2 diabetes.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / physiopathology
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Hospitals, Urban
  • Humans
  • Injections, Intravenous
  • Kidney / physiopathology*
  • Longitudinal Studies
  • Male
  • Outpatient Clinics, Hospital
  • Radiopharmaceuticals / administration & dosage
  • Radiopharmaceuticals / blood
  • Radiopharmaceuticals / pharmacokinetics
  • Renal Elimination
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / physiopathology
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Characteristics
  • Technetium Tc 99m Pentetate / administration & dosage
  • Technetium Tc 99m Pentetate / blood
  • Technetium Tc 99m Pentetate / pharmacokinetics
  • Tertiary Care Centers
  • Victoria


  • Radiopharmaceuticals
  • Technetium Tc 99m Pentetate