Modification of diet in renal disease

MDRD, per the Modification of Diet in Renal Disease study. 

The National Kidney Foundation (NKF) developed a classification system for CKD (Table 23-11.1 The staging system defines the stages of CKD based on GFR level, but also accounts for evidence of kidney damage in the absence of changes in GFR, as in stage 1 CKD. The GFR is calculated using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation ... 

MDRD Formula for Estimating Glomerular Filtration Rate (from the Modification of Diet in Renal Disease Study)3... 

Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999 130 461 470. 

Dietary protein has long been thought to play a role in the progression of chronic renal disease, but clinical trials have not consistently shown that dietary protein restriction is beneticial. A meta-analysis including the Modification of Diet in Renal Disease (MDRD) Study, of 1413 patients from 1966 to 1994 showed that dietary protein restriction slows the progression of both diabetic and non-diabetic renal disease (see Klahr et al., 1994). It is advisable to restrict protein intake moderately to 1 g/kg daily. 

Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek HW et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of diet in Renal Disease Study Group. N Engl J Med 1994 330 877-84. 

Kopple ID, Greene T, Chumlea WC, Hollinger O, Ma-roni BJ, Merrill D et al. Modification of diet in Renal disease Study Group. Relationship between nutritional status and GFR results from the MDRD study. Kidney Int 2000 57 1688-703. 

MDRD modification of diet in renal disease NRF nuclear respiratory factors... 

Calculated Clearance. The mathematical relationship between plasma creatinine and GFR can be improved by correcting for the confounding variables that make that relationship nordinear. More than 25 different formulas have been derived that estimate GFR using plasma creatinine corrected for some or all of gender, body size, race, and age. These may produce a better estimate of GFR than serum creatinine alone. Indeed the National Kidney Foundation of the United States has recommended that such estimates should be used in preference to serum creatinine, and that either the Cockcroft and Gault or Modification of Diet in Renal Disease (MDRD) formula should be used in adults. The Schwartz and Counahan-Barratt formulas are recommended for use in children. 

Lamb EJ, Webb MC, Simpson DE, Coakley AJ, Newman DJ, O Riordan SE. Estimation of glomerular filtration rate in older patients with chronic renal insufficiency is the Modification of Diet in Renal Disease formula an improvement J Am Geriatrics Soc 2003 51 1012-7. 

Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int 1997 51 1908-19. 

Estimation of creatinine clearance in vegetarians is controversial. Some clinicians advocate use of the 24-hour creatinine clearance in these patients since this method is based on the renal clearance of creatinine. The six-variable Modification of Diet in Renal Disease (MDRD) study equation (see below), which incorporates nutritional parameters such as BUN and albumin, has been suggested as an alternative approach. 

These equations were derived from multiple regression analysis of data obtained from patients enrolled in part of the Modification of Diet in Renal Disease Study (MDRD). Of the 1628 patients enrolled in the baseline phase of the study (mean GFR = 40 mL/min per 1.73 m ), 1070 were randomly assigned to a training sample, with the remaining 558 included in the validation sample. The initial regression model yielded the following six-variable equation ... 

Pierrat A, Gravier E, Saunders C, et al. Predicting GFR in children and adults a comparison of the Cockcroft-Gault, Schwartz, and modification of diet in renal disease formulas. Kidney Int 2003 64 1425-1436. 

K/DOQI Kidney Dialysis Outcomes and Quality Initiative MAP mean arterial blood pressure MDRD Modification of Diet in Renal Disease MRFIT Multiple Risk Factor Intervention Trial NHANES III Third National Health and Nutritional Examination Survey... 

The assessment of kidney function with estimated glomerular filtration rate (eGFR) using CKD-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) formulas is key for correct and safe drug prescribing. 

The Modification of Diet in Renal Disease (MDRD) equation was developed from an extensive sample of patients with known CKD, all of whom had a measured GFR <90 ml/min/1.73 m [4]. This equation is now widely reported by clinical laboratories around the world whenever Scr is measured. Since the MDRD equation overestimates measured GFR in subjects with values >60 ml/min/1.73 m, values are only reported for GFR <60 ml/min/1.73 m [3]. Use of IDMS-traceable creatinine values in the IDMS-MDRD Study equation results in a more accurate eGFR. 

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